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Tobacco Use in Canada:Patterns and Trends

2013 Edition

tobacco Use in Canada: Patterns and trends 2013 Edition

This report was prepared by Jessica Reid, MSc, and David Hammond, PhD. Data analysis was completed by Robin Burkhalter, MMath, Vicki Rynard, MSc, and Rashid Ahmed, PhD, using datasets made available by Statistics Canada and Health Canada.

This research is funded by the Canadian Cancer Society (grant #2011-701019).

Suggested citation: Reid JL, Hammond D, Burkhalter R, Rynard VL, Ahmed R. Tobacco Use in Canada: Patterns and Trends, 2013 Edition. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo.

This report is available online at www.tobaccoreport.ca and www.propel.uwaterloo.ca.

Foreword

ITobacco Use in Canada • 2013WWW.tObaccOrepOrt.ca

We are pleased to launch the fourth edition of Tobacco Use in Canada: Patterns and Trends. The look of this edition has changed, but our commitment to providing you with timely and relevant information has not. Each year it is our hope that the information in this report is of value to researchers, decision-makers and others in the tobacco control community committed to seeing an improvement in the health of Canadians through a significant reduction in tobacco use in our country.

Tobacco continues to be the leading cause of preventable death in Canada; more than overweight and obesity, physical inactivity or high blood pressurei. More than 37,000 Canadians will die prematurely this year due to tobacco useii. Each day, 100 Canadians die of a smoking-related illnessiii.

After years of declining tobacco use prevalence, rates have stalled. Approximately 4.9 million Canadians were current smokers in 2011--the same number as in 2008. Tobacco still poses a threat to the health of Canadians; for some more than others. Prevalence rates vary by age, sex, province and education level. For example, although fewer children and youth are starting to smoke, this may represent delayed onset, since young adults (aged 20-34) now have the highest prevalence rate.

This edition of the report provides, for the first time, data on the use of flavoured tobacco among youth. This shift from cigarettes to other forms of tobacco is a real concern, as more youth aged 15-19 have smoked a cigarillo than have smoked a whole cigarette.

For more information relevant to your work, we refer you to the annual publication Canadian Cancer Statistics produced annually by the Canadian Cancer Society in partnership with the Public Health Agency of Canada, Statistics Canada, and provincial / territorial cancer registries, and to the Ontario Tobacco Research Unit’s Tobacco Informatics Monitoring System.

The Propel Centre for Population Health Impact is grateful to the Canadian Cancer Society for their enduring and outstanding leadership in cancer prevention and tobacco control, and for supporting this report. Sincere thanks, also, to Jessica Reid, David Hammond and their team for producing this report. We trust that it will help guide and support research, advocacy and programs.

BarBara riley, Phd Executive Director Propel Centre for Population Health Impact

PaUl laPierreVice President Public Affairs and Cancer Control Canadian Cancer Society

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This report uses data from national surveys conducted by Health Canada and Statistics Canada to summarize the main patterns and trends in tobacco use in Canada, primarily between 1999 and 2011, with a focus on the current year. Highlights of the report are presented below.

SECtion i: tobaCCo USE among Canadian adUltS (15+), 2011Smoking Prevalence •17.3%ofCanadians(approximately4.9million)werecurrentsmokers. •Themajorityofsmokersreportedsmokingdaily(13.8%daily/3.6%non-dailyprevalence). •Thedeclineinsmokingprevalenceobservedoverthepastdecadeappearstohaveslowed. •Prevalencewashigheramongmales(19.7%)thanfemales(15.0%). •Smokingprevalencewashighestamongyoungadultsaged25-34and20-24,at23.8%and

21.5%,respectively. •Despitedecliningprevalence,substantialdifferencesinsmokingprevalencebyeducationlevel

persisted over the last decade, particularly for having a university degree vs. not. •Thereweresignificantdifferencesbetweenprovincesinsmokingprevalence.

Cigarette Consumption •DailysmokersinCanadasmokedanaverageof14.4cigarettesperday. •Averageconsumptionhasdeclinedby3cigarettesperdaysince1999. •Malesmokersconsumedapproximately2cigarettesmoreperdaythanfemales.Sexdifferences

in consumption appear to have remained fairly stable since 1999.

Use of other tobacco Products •Cigarillosandcigarswerethemostpopulartobaccoproductsotherthancigarettes:3.4%of

Canadians reported use in the past 30 days. •Useofothertobaccoproducts(includingcigars,cigarillos,pipe,chewingtobacco/snuff,and

waterpipe) was more prevalent among males than females. •Roll-your-owntobaccowasusedatleastsometimesbyapproximatelyoneintensmokers. •Provincesdifferedsignificantlyinuseofroll-your-owntobaccoandothertobaccoproducts.

SECtion ii: QUitting Smoking, 2011 •SixoutoftenCanadianswhohaveeverbeensmokershavenowquit.

Plans to Quit •Nearlytwo-thirdsofsmokerswereseriouslyconsideringquittinginthenext6months;

3in10wereconsideringquittinginthenextmonth. •Similarpercentagesofmalesandfemaleswereconsideringquitting. •Planstoquitvariedbyagegroup,andwerehighestamongsmokersaged25-34.

Quit attempts and Success (abstinence) •Almosthalfofsmokershadtriedtoquitinthepastyear.Threeintenhadtriedmorethanonce. •Similarpercentagesofmalesandfemaleshadmadeaquitattempt. •Greaterpercentagesofyoungersmokershadtriedtoquit,comparedtooldersmokers. •Amongrespondentswhohadmadeaquitattemptinthepastyear,approximatelyoneinten

were still abstinent from smoking at the time they were surveyed.

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Quit methods and Cessation assistance •Themostcommonstrategyfortryingtoquitsmokingwasto“reducethenumberofcigarettes

smoked,”usedbyaroundtwo-thirdsofsmokerswhoattemptedtoquit. •Nearly6in10smokerswhoattemptedtoquitusedsomeformofcessationassistance. •Stop-smokingmedications,includingnicotinereplacementtherapy,wereusedbynearlyhalf

(46%)ofthosewhoattemptedtoquit,andusevariedbyproductandbyprovince. •Lessthanaquarterofsmokers“madeadealwithafriendorfamilymembertoquittogether.” •Fewsmokers(<5%)usedservicessuchastelephonequitlinesorworkplaceinterventions. •Over60%ofsmokerswhovisitedadoctorinthepastyearhadreceivedadvicetoquit.

SECtion iii: tobaCCo USE among Canadian YoUthYouth in grades 6-9, in 2010-11: •15.5%ofstudentsingrades6-9hadevertriedacigarette. •2.2%ofstudentsingrades6-9werecurrentsmokersoverall,withgrade-specificratesranging

fromtoolowtoreportingrade6and0.7%forgrade7,to4.9%forgrade9students. •Smokerswerefairlyevenlysplitbetweendaily(0.9%)andnon-daily(1.2%)smoking. •Similarpercentagesofmales(2.2%)andfemales(2.1%)werecurrentsmokers. •Prevalencevariedbyprovince,andwashighestinQuebecandSaskatchewan,at4.3%. •Nearlyonethirdofnever-smokersingrades6-9wereclassifiedassusceptibletosmoking. •Dailysmokersingrades7-9smokedanaverageof8.7cigarettesperday. •7.5%ofstudentsingrades6-9hadeversmokedacigarorcigarillo. •Mostsmokersingrades6-9usuallyobtainedtheircigarettesfromsocialsources. •Sevenoutoftencurrentsmokersingrades6-9reportedevertryingtoquitsmoking.

Youth aged 15-19, in 2011: •Oneinfour(24.3%)youthreportedeverhavingsmokedawholecigarette. •11.8%ofyouthaged15-19werecurrentsmokersoverall,withage-specificratesrangingfrom5.1%

for15-year-oldsto21.0%for19-year-olds. •Similarpercentagesofyouthsmokeddaily(6.0%)andnon-daily(5.8%). •Prevalencewas13.0%amongmalesand10.5%amongfemales,whichwerenot

significantly different. •Prevalencevariedbyprovince,rangingfromjustover8%inAlbertatonearly20%in

Saskatchewan. •Dailysmokersaged15-19smokedanaverageof11.7cigarettesperday. •17%ofyouthaged15-19hadeversmokedacigar,and27%hadeversmokedacigarillo. •Genderdifferenceswereapparent:24%ofmalesand9%offemaleshadsmokedacigar,

while one third of males and one in five females had smoked a cigarillo. •55%ofsmokersaged15-18usuallyobtainedcigarettesfromretailsources,whilemorethana

third obtained them through social sources. •56%ofsmokersaged15-19wereseriouslyconsideringquittinginthenext6months. •Two-thirdsofsmokersaged15-19hadmadeaquitattemptinthepast12months.

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aboUt thiS rEPortThis report is the fourth edition in a series of annual reports on tobacco use in Canada. It was developed by the Propel Centre for Population Health Impact at the University of Waterloo. The report uses data from national surveys conducted by Health Canada and Statistics Canada to summarize the main patterns and trends in tobacco use in Canada, primarily between 1999 and 2011, with a focus on the current year.

The report is intended to serve as a reference on current patterns of tobacco use in Canada, for public health professionals, policy makers, researchers, and members of the tobacco control community. It may also be useful for the media and members of the public with an interest in tobacco control.

The contents of this report are available online at www.tobaccoreport.ca and www.propel.uwaterloo.ca. In addition to the main report content, the website also includes data tables for all the figures contained in this report in order to enable the extraction of more precise numbers, as well as confidence intervals for all reported estimates. Previous editions of the report may also be accessed through the website.

data SoUrCESCanadian tobacco Use monitoring Survey (CtUmS)The Canadian Tobacco Use Monitoring Survey (CTUMS) is conducted by Statistics Canada with the cooperation and support of Health Canada. CTUMS was developed to provide Health Canada and its partners with timely, reliable, and continual data on tobacco use and related issues. Starting in 1999, data have been collected from February to December of each year, using computer-assisted random-digit-dialed telephone interviews. The samples for CTUMS are selected using a stratified random sampling procedure. The samples include the population of Canada aged 15 years and over, excluding residents of Yukon, Northwest Territories and Nunavut, as well as full-time residents of institutions and residents without telephones or with cell phones only.

See Appendix A for further details.

Youth Smoking Survey (YSS)TheYouthSmokingSurvey(YSS)monitorstobaccouseinschool-agedchildren(grades6-9/10-12).The YSS collects data on smoking behaviour, social and demographic factors, attitudes and beliefs about smoking, cigarette purchasing and other policy-relevant items, as well as experience with alcoholanddrugs.Todate,sixwavesoftheYSShavebeenconducted:1994,2002,2004-05,2006-07, 2008-09, and 2010-11. YSS data is collected through classroom-based surveys of students in grades6-9(andgrades10-12in2006-07,2008-09,and2010-11;grade5wasalsoincludedinwavespriortoandincluding2006-07).Schoolsarerandomlysampledwithineachofthe10provinces,usinga stratified single stage design. The sample excludes residents of the Yukon, Nunavut and Northwest Territories, residents of institutions, residents of First Nations reserves, and those attending special schools (e.g., schools for visually- or hearing-impaired individuals) or schools located on military bases. Participation to the 2010-11 YSS was declined by the province of New Brunswick; based on the comparative analysis conducted using 2008-09 survey data, there were no statistically significant differences in national estimates with and without New Brunswick.

See Appendix B for further details.

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analYSiSThe data presented in this report are weighted estimates, generated using SAS 9.2 unless otherwise noted. The CTUMS survey weights assigned by Statistics Canada in the annual datasets were used for CTUMS analyses, and the YSS survey weights were used for YSS analyses. CTUMS and YSS were not analysed together and there was no overlap of the survey weights between the two surveys. Confidence intervals around estimates were calculated in STATA 10.1 using bootstrap weights for the years where bootstrap weight data are available.

Statistical comparisons between groups/years were tested using weighted regression analyses in SAS 9.2. Bootstrap weights were used to perform significance testing where available. Where statistical testing has been performed, comparisons are marked with a superscript number, which refers to a p-value that can be found in the Index of Statistical Tests (page 91-92). Throughout the report, the term“significant”hasbeenreservedforinstanceswherestatisticaltestinghasbeenperformed,withp<0.05asthecut-offforsignificance. See Appendix C for further details.

Data analysis was completed by Robin Burkhalter, MMath, Vicki Rynard, MSc, and Rashid Ahmed, PhD, of the Propel Centre for Population Health Impact, using datasets made available by Statistics Canada and Health Canada. Statistical review was provided by K. Stephen Brown, PhD, of the Propel Centre for Population Health Impact and the Department of Statistics & Actuarial Science, University of Waterloo.

This report does not necessarily reflect the views or opinions of Statistics Canada or Health Canada.

Please note that unless otherwise stated, all data reported in Sections I and II is for Canadian adults age 15 and over, from the Canadian Tobacco Use Monitoring Survey (CTUMS), and all data reported inSectionIIIisforCanadianyouth,grades6-9fromtheYouthSmokingSurvey(YSS)andage15-19from CTUMS (see p. 96).

the 2013 EditionThis edition updates the previous (2012) edition with current data, including the 2011 wave of CTUMS and the 2010-11 wave of the YSS.

We welcome your feedback on this report. Please send any comments to the contact below.

For further information or to request a print copy of the report, please contact:

Propel Centre for Population Health ImpactUniversity of Waterloo200 University Ave. W.Waterloo,ONCanadaN2L3G1Phone: (519) 888-4520Fax:(519)886-6424Email: [email protected] Web: www.propel.uwaterloo.ca

Suggested citation: Reid JL, Hammond D, Burkhalter R, Rynard VL, Ahmed R. Tobacco Use in Canada: Patterns and Trends, 2013 Edition. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo.

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Section i: tobacco Use among Canadian adults................................... 13highlights ...................................................................................................................... 131. Smoking in Canada ..................................................................................................14

1.1 Historical Trends in Smoking Prevalence ......................................................................................................141.2 Current Smoking Prevalence ............................................................................................................................15

Demographic Patterns in Smoking Prevalence ....................................................................................... 16Smoking Prevalence by Sex ..........................................................................................................................16Smoking Prevalence by Age ......................................................................................................................... 17Smoking Prevalence by Education Level .................................................................................................18

1.3 Cigarette Consumption ......................................................................................................................................19Demographic Patterns in Cigarette Consumption ................................................................................. 19

Cigarette Consumption by Sex ....................................................................................................................19Cigarette Consumption by Age ................................................................................................................. 20Cigarette Consumption by Education Level ...........................................................................................21

2. Smoking in the Provinces ...................................................................................... 222.1 British Columbia ...................................................................................................................................................24

Smoking prevalence ........................................................................................................................................24Cigarette consumption ..................................................................................................................................25

2.2 Alberta ....................................................................................................................................................................26Smoking prevalence ........................................................................................................................................26Cigarette consumption ..................................................................................................................................27

2.3 Saskatchewan .......................................................................................................................................................28Smoking prevalence ........................................................................................................................................28Cigarette consumption ..................................................................................................................................29

2.4 Manitoba ............................................................................................................................................................... 30Smoking prevalence ....................................................................................................................................... 30Cigarette consumption ...................................................................................................................................31

2.5 Ontario ....................................................................................................................................................................32Smoking prevalence ........................................................................................................................................32Cigarette consumption ..................................................................................................................................33

2.6Quebec ...................................................................................................................................................................34Smoking prevalence ........................................................................................................................................34Cigarette consumption ..................................................................................................................................35

2.7 New Brunswick ....................................................................................................................................................36Smoking prevalence ........................................................................................................................................36Cigarette consumption ..................................................................................................................................37

2.8 Nova Scotia ...........................................................................................................................................................38Smoking prevalence ........................................................................................................................................38Cigarette consumption ..................................................................................................................................39

2.9 Prince Edward Island ........................................................................................................................................ 40Smoking prevalence ....................................................................................................................................... 40Cigarette consumption ...................................................................................................................................41

2.10 Newfoundland & Labrador ............................................................................................................................42Smoking prevalence ........................................................................................................................................42Cigarette consumption ..................................................................................................................................43

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3. Cigarette Sources and Purchasing .......................................................................44Usual Sources of Cigarettes .................................................................................................................................. 44Contraband and Cheaper Cigarettes ................................................................................................................ 44Purchasing Cigarettes – Sources .........................................................................................................................45

Purchasing from Stores & Discount Cigarettes ....................................................................................45Purchasing from First Nations .....................................................................................................................45Purchasing Smuggled Cigarettes ..............................................................................................................45

4. Use of other tobacco Products in Canada .........................................................464.1 Prevalence of Use of Other Tobacco Products ....................................................................................... 46

Demographic Patterns in Other Tobacco Use ........................................................................................ 47Other Tobacco Use by Sex ...........................................................................................................................47Other Tobacco Use by Age ..........................................................................................................................48Other Tobacco Use by Province .................................................................................................................49

Flavoured Tobacco Products .......................................................................................................................494.2 Use of Roll-Your-Own Tobacco .................................................................................................................... 50

Demographic Patterns in Roll-Your-Own Tobacco Use ........................................................................ 51Roll-Your-Own Tobacco Use by Sex...........................................................................................................51Roll-Your-Own Tobacco Use by Age..........................................................................................................51Roll-Your-Own Tobacco Use by Province ...............................................................................................52

Section ii: Quitting Smoking .....................................................................53highlights ..................................................................................................................... 535. Quitting behaviours and outcomes ..................................................................... 545.1QuitterPercentage ..............................................................................................................................................54

QuitterPercentagebySex ...........................................................................................................................55QuitterPercentagebyAge ..........................................................................................................................56

5.2QuitIntentions .....................................................................................................................................................57QuitIntentionsbySex ....................................................................................................................................58QuitIntentionsbyAge ...................................................................................................................................59

5.3QuitAttempts .....................................................................................................................................................60QuitAttemptsbySex ......................................................................................................................................61QuitAttemptsbyAge ....................................................................................................................................62

5.4QuitSuccess(PointAbstinence) ..................................................................................................................63QuitSuccessbySex ....................................................................................................................................... 64QuitSuccessbyAge .......................................................................................................................................65

6. Use of Cessation assistance ................................................................................. 666.1CessationMethods .............................................................................................................................................666.2UseofPharmacotherapy .................................................................................................................................67

Use of pharmacotherapy by province ......................................................................................................676.3CessationAdviceandAssistancefromHealthProfessionals ............................................................68

Cessation advice and assistance from health professionals by province ...................................69

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Section iii: tobacco Use among Canadian Youth ................................ 70highlights ..................................................................................................................... 707. Smoking initiation ....................................................................................................71

7.1 Ever Smoking .........................................................................................................................................................71Eversmokingamongstudentsingrades6-9 ........................................................................................71Ever smoking among youth aged 15-19 ...................................................................................................73

7.2 Susceptibility to Smoking ...............................................................................................................................73Susceptibility to smoking by grade ..........................................................................................................74Susceptibility to smoking by province .....................................................................................................74

8. Current Smoking among Youth ............................................................................ 75 8.1 Smoking Prevalence ..........................................................................................................................................75

Smoking Prevalence by Age ........................................................................................................................76Smoking Prevalence by Sex .........................................................................................................................77Smoking Prevalence by Province ...............................................................................................................78

8.2 Cigarette Consumption .................................................................................................................................. 80Cigarette Consumption by Sex .................................................................................................................. 80Cigarette Consumption by Age ...................................................................................................................81

9. Sources of Cigarettes ............................................................................................. 82Sourcesofcigarettesforstudentsingrades6-9 .........................................................................................82 Sources of cigarettes for 15- to 18-year-olds ..................................................................................................83

10. Use of other tobacco Products .......................................................................... 84Flavoured Tobacco Products .......................................................................................................................85Demographic Patterns in Other Tobacco Use ........................................................................................85

Use of Other Tobacco Products by Sex ...................................................................................................85Use of Other Tobacco Products by Province ........................................................................................86

11. Quitting Smoking ................................................................................................... 8711.1QuitIntentions .....................................................................................................................................................8711.2QuitAttempts .....................................................................................................................................................88

Quitattemptsamongstudentsingrades6-9 ......................................................................................88Quitattemptsamongyouthaged15-19 ..................................................................................................89

glossary ....................................................................................................... 90CTUMS ........................................................................................................................................................................... 90YSS .................................................................................................................................................................................. 90

index of Statistical tests ............................................................................ 91references .................................................................................................. 93appendices

Appendix A: Canadian Tobacco Use Monitoring Survey ........................................................................... 94Appendix B: Youth Smoking Survey .................................................................................................................. 94Appendix C: Data Analysis .....................................................................................................................................95

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list of tablestable 2.1: Smoking prevalence by province, 1999-2011 .....................................................................................22table 2.2: Average daily cigarette consumption by province, 1999-2011 ...................................................23table 4.1: Prevalence of use in past 30 days for cigars/cigarillos, by province, 1999-2011 .................49table 4.2: Prevalence of roll-your-own tobacco use among current smokers, by province, 2000-2011 .............................................................................................................................52table 4.3: Provincial and federal tax on cigarettes and roll-your-own tobacco, as of April 24, 2011 .......................................................................................................................................52table 6.1: Prevalence of use of stop-smoking medications among current and former smokers

whohadquitorattemptedtoquitsmokinginthepast2years,byprovince,2011 ..........67table 6.2: Percentageofcurrentsmokerswhoreceivedadvicetoquitfromhealth

professionals in the past 12 months, 2011 ...........................................................................................69table 8.1: Currentsmokingprevalencebyprovince,grades6-9,1994-2011 .............................................78table 8.2: Current smoking prevalence by province, age 15-19, 1999-2011 ................................................79table 10.1: Percentageofyouthingrades6-9whohadevertriedvarioustobaccoproducts,

by province, 2010-11 ....................................................................................................................................86table 10.2: Percentage of youth aged 15-19 who had ever tried various tobacco products, by province, 2011 ..........................................................................................................................................86

list of FiguresFigure 1.1: SmokingprevalenceinCanada,adultsaged15+,1965-2011 ................................................................. 14Figure 1.2: Current smoking prevalence, adults aged 15+, 2011 ...................................................................................15Figure 1.3: Current smoking prevalence, adults aged 15+, 1999-2011 ........................................................................15Figure 1.4: Current smoking prevalence by sex, 2011 ........................................................................................................16Figure 1.5: Current smoking prevalence by sex, 1999-2011 ............................................................................................16Figure 1.6: Current smoking prevalence by age group, 2011 .........................................................................................17Figure 1.7: Current smoking prevalence by age group, 1999-2011 .............................................................................17Figure 1.8: Current smoking prevalence by educational attainment, 2011 ..............................................................18Figure 1.9: Current smoking prevalence by educational attainment, 1999-2011 ..................................................18Figure 1.10: Average daily cigarette consumption, overall and by sex, 1999-2011 ................................................19Figure 1.11: Average daily cigarette consumption by age group, 2011 ....................................................................20Figure 1.12: Average daily cigarette consumption by age group, 1999-2011 .........................................................20Figure 1.13: Average daily cigarette consumption by educational attainment, 2011 ...........................................21Figure 1.14: Average daily cigarette consumption by educational attainment, 1999-2011 ................................21Figure 2.1: Smoking prevalence by province, 2011 ............................................................................................................22Figure 2.2: Average daily cigarette consumption by province, 2011 .........................................................................23Figure 2.3: Current smoking prevalence by sex, British Columbia, 1999-2011 ..................................................... 24Figure 2.4: Current smoking prevalence by age group, British Columbia, 1999-2011 .......................................25Figure 2.5: Average daily cigarette consumption by sex, British Columbia, 1999-2011 ...................................25Figure 2.6: Current smoking prevalence by sex, Alberta, 1999-2011 ........................................................................ 26Figure 2.7: Current smoking prevalence by age group, Alberta, 1999-2011 ..........................................................27Figure 2.8: Average daily cigarette consumption by sex, Alberta, 1999-2011 .......................................................27Figure 2.9: Current smoking prevalence by sex, Saskatchewan, 1999-2011 ...........................................................28Figure 2.10: Current smoking prevalence by age group, Saskatchewan, 1999-2011 ........................................... 29Figure 2.11: Average daily cigarette consumption by sex, Saskatchewan, 1999-2011 ....................................... 29

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Figure 2.12: Current smoking prevalence by sex, Manitoba, 1999-2011 ....................................................................30Figure 2.13: Current smoking prevalence by age group, Manitoba, 1999-2011 .......................................................31Figure 2.14: Average daily cigarette consumption by sex, Manitoba, 1999-2011 ....................................................31Figure 2.15: Current smoking prevalence by sex, Ontario, 1999-2011 .........................................................................32Figure 2.16: Current smoking prevalence by age group, Ontario, 1999-2011 ..........................................................33Figure 2.17: Average daily cigarette consumption by sex, Ontario, 1999-2011 ......................................................33Figure 2.18:Currentsmokingprevalencebysex,Quebec,1999-2011 ....................................................................... 34Figure 2.19:Currentsmokingprevalencebyagegroup,Quebec,1999-2011 .........................................................35Figure 2.20:Averagedailycigaretteconsumptionbysex,Quebec,1999-2011 ......................................................35Figure 2.21: Current smoking prevalence by sex, New Brunswick, 1999-2011 .......................................................36Figure 2.22: Current smoking prevalence by age group, New Brunswick, 1999-2011 .........................................37Figure 2.23: Average daily cigarette consumption by sex, New Brunswick, 1999-2011 ......................................37Figure 2.24: Current smoking prevalence by sex, Nova Scotia, 1999-2011 .............................................................. 38Figure 2.25: Current smoking prevalence by age group, Nova Scotia, 1999-2011 ................................................ 39Figure 2.26: Average daily cigarette consumption by sex, Nova Scotia, 1999-2011 ............................................ 39Figure 2.27: Current smoking prevalence by sex, Prince Edward Island, 1999-2011 ...........................................40Figure 2.28: Current smoking prevalence by age group, Prince Edward Island, 1999-2011 ...............................41Figure 2.29: Average daily cigarette consumption by sex, Prince Edward Island, 1999-2011 ...........................41Figure 2.30: Current smoking prevalence by sex, Newfoundland & Labrador, 1999-2011 ................................ 42Figure 2.31: Current smoking prevalence by age group, Newfoundland & Labrador, 1999-2011 ................. 43Figure 2.32: Average daily cigarette consumption by sex, Newfoundland & Labrador, 1999-2011 .............. 43Figure 3.1: Percentage of smokers who usually get cigarettes from various sources, 2011 .........................44Figure 3.2: Percentage of smokers who had purchased (any) cigarettes from varioussourcesinthepast6months,2011 ................................................................................................... 45Figure 4.1: Prevalence of use in the past 30 days for various tobacco products, 2011 ...................................46Figure 4.2: Prevalence of use in the past 30 days for various tobacco products, 1999-2011 .......................46Figure 4.3: Prevalence of use in the past 30 days for various tobacco products, by sex, 2011 ....................47Figure 4.4: Prevalence of use in the past 30 days for cigars/cigarillos, by sex, 1999-2011 .............................47Figure 4.5: Prevalence of use in the past 30 days for various tobacco products, by age group, 2011 ....48Figure 4.6: Prevalence of use in the past 30 days for cigars/cigarillos, by age group, 1999-2011 .............48Figure 4.7: Prevalence of roll-your-own tobacco use among current smokers, 2011 .......................................50Figure 4.8: Prevalence of roll-your-own tobacco use among current smokers, 2000-2011 .........................50Figure 4.9: Prevalence of roll-your-own tobacco use among current smokers, by sex, 2011 .........................51Figure 4.10: Prevalence of roll-your-own tobacco use among current smokers, by age group, 2011 ..........51Figure 5.1: Percentage of respondents who had ever smoked (current and former smokers), andquitterpercentage,1999-2011 .................................................................................................................... 54Figure 5.2: Percentage of respondents who had ever smoked (current and former smokers), andquitterpercentage,bysex,2011.................................................................................................................55Figure 5.3: Percentage of males who had ever smoked (current and former smokers), andquitterpercentage,1999-2011 .....................................................................................................................55Figure 5.4: Percentage of females who had ever smoked (current and former smokers), andquitterpercentage,1999-2011 .....................................................................................................................55Figure 5.5: Quitterpercentageamongeversmokers,byagegroup,2011............................................................56Figure 5.6: Quitterpercentageamongeversmokers,byagegroup,1999-2011 ................................................56

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Figure 5.7: Percentageofsmokerswhowereseriouslyconsideringquittinginthenext6months, and in the next 30 days, 2011 ...............................................................................................................................57Figure 5.8: Percentageofsmokerswhowereseriouslyconsideringquittinginthenext6months, and in the next 30 days, 1999-2011 ....................................................................................................................57Figure 5.9: Percentageofsmokerswhowereseriouslyconsideringquittinginthenext6months, and in the next 30 days, by sex, 2011 ............................................................................................................... 58Figure 5.10:Percentageofsmokerswhowereseriouslyconsideringquittinginthenext6months, and in the next 30 days, by sex, 1999-2011 ................................................................................................... 58Figure 5.11: Percentageofsmokerswhowereseriouslyconsideringquittinginthenext6months, and in the next 30 days, by age group, 2011 ................................................................................................ 59Figure 5.12:Percentageofsmokerswhowereseriouslyconsideringquittinginthenext6months, by age group, 1999-2011 ........................................................................................................................................ 59Figure 5.13:Numberofquitattemptsmadeinthepast12monthsbysmokersand recentquitters,2011 .................................................................................................................................................60Figure 5.14:Percentageofsmokersandrecentquitterswhoattemptedtoquitinthe past 12 months, 1999-2011 .....................................................................................................................................60Figure 5.15:Percentageofsmokersandrecentquitterswhoattemptedtoquitinthe past 12 months, by sex, 2011 ...................................................................................................................................61Figure 5.16:Percentageofsmokers(andrecentquitters)whoattemptedtoquitinthe past 12 months, by sex, 1999-2011 .......................................................................................................................61Figure 5.17:Percentageofsmokersandrecentquitterswhoattemptedtoquitinthe past 12 months, by age group, 2011 ..................................................................................................................62Figure 5.18:Percentageofsmokersandrecentquitterswhoattemptedtoquitinthe past 12 months, by age group, 1999-2011 ......................................................................................................62Figure 5.19:Percentageofcurrentsmokersandrecentquitterswhoattemptedtoquitinthe past 12 months and were still abstinent at the time of survey, 2004-2011 ....................................63Figure 5.20:Percentageofcurrentsmokersandrecentquitterswhoattemptedtoquitinthe past 12 months and were abstinent at the time of survey, by sex, 2011 ..........................................64Figure 5.21:Percentageofcurrentsmokersandrecentquitterswhoattemptedtoquitinthe past 12 months and were abstinent at the time of survey, by sex, 2004-2011 .............................64Figure 5.22:Percentageofcurrentsmokersandrecentquitterswhoattemptedtoquitinthe past 12 months and were abstinent at the time of survey, by age group, 2011 ...........................65Figure 5.23:Percentageofcurrentsmokersandrecentquitterswhoattemptedtoquitinthe past 12 months and were abstinent at the time of survey, by age group, 2004-2011 ..............65Figure 6.1: Prevalenceofuseofvariousquitmethodsamongcurrentandformersmokerswho hadquitorattemptedtoquitsmokinginthepast2years,2011 .......................................................66Figure 6.2: Prevalenceofuseofvariousquitmethodsamongcurrentandformersmokerswho hadquitorattemptedtoquitsmokinginthepast2years,2003-2011 ..........................................66Figure 6.3: Prevalence of use of stop-smoking medications among current and former smokerswhohadquitorattemptedtoquitsmokinginthepast2years,2003-2011 .............67Figure 6.4: Percentageofcurrentsmokerswhoreceivedadvicetoquitandinformationon quittingassistancefromhealthprofessionalsinthepast12months,2011 ....................................68Figure 6.5: Percentageofvisitorstohealthprofessionalswhoreceivedadvicetoquitinthe past 12 months, 2003-2011 ...................................................................................................................................68Figure 6.6: Percentage of those who received advice who also received information about quittingassistanceinthepast12months,2003-2011 .............................................................................69Figure 7.1: Smokingstatusofstudentsingrades6-9whohadevertried smoking cigarettes, 2010-11 ....................................................................................................................................71

TaBle oF ConTenTs

XII Tobacco Use in Canada • 2013WWW.tObaccOrepOrt.ca

Figure 7.2: Percentageofstudentsingrades6-9whohadevertriedsmokingacigarette, by grade, 1994-2010-11 ............................................................................................................................................72Figure 7.3: Percentageofstudentsingrades6-9whohadevertriedsmokingacigarette, by province, 2010-11 ..................................................................................................................................................72Figure 7.4: Percentage of youth aged 15-19 who had ever smoked a whole cigarette, by age, 1999-2011 .......................................................................................................................................................73Figure 7.5: Percentageofnever-smokersingrades6-9whoweresusceptibletosmoking, by grade, 1994-2010-11 ............................................................................................................................................74Figure 7.6: Percentageofnever-smokersingrades6-9whoweresusceptibletosmoking, by province, 2010-11 ..................................................................................................................................................74Figure 8.1: Currentsmokingprevalence,grades6-9,2010-11,andage15-19,2011 .............................................75Figure 8.2: Currentsmokingprevalence(dailyandnon-daily),grades6-9andage15-19,1994-2011 ......75Figure 8.3: Current smoking prevalence by grade/age, grades 7-9, 2010-11, and age 15-19, 2011 ...............76Figure 8.4: Current smoking prevalence by grade/age, grades 7-9 and age 15-19, 1994-2011 .....................76Figure 8.5: Currentsmokingprevalencebysex,grades6-9,2010-11,andage15-19,2011 ..............................77Figure 8.6: Current smoking prevalence (daily and non-daily) by sex, grades6-9andage15-19,1994-2011 .................................................................................................................77Figure 8.7: Currentsmokingprevalencebyprovince,grades6-9,2010-11 ............................................................78Figure 8.8: Current smoking prevalence by province, age 15-19, 2011 ......................................................................79Figure 8.9: Average daily cigarette consumption by sex, grades 7-9, 2010-11, and age 15-19, 2011 ...........80Figure 8.10: Average daily cigarette consumption by sex, grades 7-9 and age 15-19, 1994-2011 .................80Figure 8.11: Average daily cigarette consumption by age, grades 7-9, 2010-11, and age 15-19, 2011 ............81Figure 8.12: Average daily cigarette consumption by age group, grades 7-9 and age 15-19, 1994-2011 ...................................................................................................................................................81Figure 9.1: Usualsourcesofcigarettesforcurrentsmokersingrades6-9,2010-11 ..........................................82Figure 9.2: Percentage of smokers aged 15-18 who usually get cigarettes from various sources, 2011 ............................................................................................................................................... 83Figure 9.3: Percentage of smokers aged 15-18 who were asked for ID or refused sale

of cigarettes, among those who usually buy cigarettes from a store or bought them in the past 12 months, 2011 ....................................................................................................................... 83

Figure 10.1: Percentage of youth who had ever tried various tobacco products, grades6-9,2010-11,andage15-19,2011 ......................................................................................................... 84Figure 10.2:Percentageofyouthingrades6-9andage15-19whohadevertried various tobacco products, 1994-2011 .............................................................................................................. 84Figure 10.3: Percentage of youth who had used flavoured tobacco products, among last

30-dayusers,grades6-9,2010-11,andage15-19,2011andage15-19,2011 ................................... 85Figure 10.4: Percentage of youth who had ever tried various tobacco products, bysex,grades6-9,2010-11,andage15-19,2011 .......................................................................................... 85Figure 11.1: Percentageofsmokersaged15-19seriouslyconsideringquittinginthenext 6months,andinthenext30days,2000-2011 ............................................................................................87Figure 11.2: Numberofquitattemptsevermadebycurrentsmokers,grades6-9,2010-11 .......................... 88Figure 11.3: Percentageofcurrentsmokerswhohadevermadeaquitattempt, grades6-9,1994-2010-11 ....................................................................................................................................... 88Figure 11.4: Numberof24-hourquitattemptsmadeinthepast12monthsbysmokersand recentquitters,aged15-19,2011 ......................................................................................................................... 89Figure 11.5: Percentageofsmokersandrecentquitterswhoattemptedtoquitinthe past 12 months, by age group, 1999-2011 ...................................................................................................... 89

1313

17.3% of Canadians (approximately 4.9 million) were current smokers. (page 15)

Themajorityofsmokersreportedsmokingdaily(13.8%daily/3.6%non-dailyprevalence).(p. 15)

the decline in smoking prevalence observed over the past decade appears to have slowed. (p. 15)

Smoking prevalence was higher among males (19.7%)thanfemales(15.0%),forbothdailyandnon-daily smoking. (p. 16)

Prevalence was highest among young adults (23.8%amongthoseaged25-34,and21.5%among those aged 20-24), and generally declined with age. Prevalence was lowest among youth aged 15-19. (p. 17)

Substantial differences in smoking prevalence by education level persisted over the last decade, despite declining prevalence. Prevalence among university graduates was less than half that of all other educational groups. (p. 18)

daily smokers in Canada smoked an average of 14.4 cigarettes per day. (p. 19)

•Averageconsumptionhasdeclinedby 3 cigarettes per day since 1999. (p. 19)

Male daily smokers consumed approximately 2 more cigarettes per day than females. (p. 19)

Daily cigarette consumption decreased with increasing education level. (p. 21)

there were significant differences between provinces in smoking prevalence, cigarette consumption, use of roll-your-own tobacco, and use of other tobacco products. (p. 22, 23, 50, 53)

•Smokingprevalencerangedfrom14%in BCtonearly20%inQuebec. (p. 22)

Cigars and cigarillos were the most popular tobaccoproductsotherthancigarettes:3.4% of Canadians reported use in the past 30 days. (p. 46)

Roll-your-own tobacco was used by approximately one in ten smokers. (p. 51)

many smokers made efforts to purchase cheaper cigarettes: more than half had recently purchased discount brands, and approximately one in ten had purchased from a First Nations reserve. Few smokers reported having purchased cigarettes that may have been smuggled. (p. 45)

In 2011, among Canadians age 15 and older:

Tobacco Use in Canada • 2013WWW.tObaccOrepOrt.ca

Section i: Tobacco Use

Among Canadian Adults

highlighTs

I: ADULTSSMOKING

PREVALENCE

14 Tobacco Use in Canada • 2013www.tobaccoreport.ca

1. Smoking in Canada1.1 hiStoriCal trEndS in Smoking PrEvalEnCEOver the past four and a half decades, there has been a substantial drop in smoking in Canada: about halfofCanadianssmokedin1965,comparedtofewerthan2outof10in2011(Figure1.1).Althoughthe overall smoking rate has decreased fairly steadily, this decline appears to have slowed in the most recent years. Historically large sex differences in smoking prevalence have narrowed over time to within a few percentage points, although smoking rates have remained higher among males.

*INCLUDES DAILY AND NON-DAILY SMOKERS

data SoUrCES: DATASOURCES:1965-1986:ACRITICALREvIEWOFCANADIANSURvEYDATAONTOBACCOUSE,ATTITUDESANDKNOWLEDGE(HEALTHANDWELFARECANADA,1988);19891989:SMOKINGBEHAvIOUROFCANADIANS:ANATIONALALCOHOLANDOTHERDRUGSSURvEYREPORT,1989(HEALTHANDWELFARE CANADA, 1992); 1990: CANADA’S HEALTH PROMOTION SURVEY 1990: TECHNICAL REPORT (HEALTH AND WELFARE CANADA, 1993); 1991: HEALTH STATUSOFCANADIANS:REPORTOFTHE1991GENERALSOCIALSURvEY(STATISTICSCANADA);1994:NATIONALPOPULATIONHEALTHSURvEY(STATISTICSCANADA);1995,1996:GENERALSOCIALSURvEY(STATISTICSCANADA)[ALLASQUOTEDIN:PHYSICIANSFORASMOKEFREECANADA,SMOKINGINCANADA,2008iv];1999-2011:CANADIANTOBACCOUSEMONITORINGSURvEY(HEALTHCANADA)

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15Tobacco Use in Canada • 2013www.tobaccoreport.ca

1.2 CUrrEnt Smoking PrEvalEnCEIn 2011, the overall prevalence of smoking in Canada was17.3%,orapproximately4.9millionCanadians:13.8%(3.9million)dailyand3.6%(1.0million)non-daily smokers (Figure 1.2). Although this appears to be a slight increase from the 2010 prevalence of 16.7%,thischangewasnotstatisticallysignificant1.

Between 2010 and 2011, neither daily2 nor non-daily smoking3 prevalence changed significantly.

As shown in Figure 1.3, overall smoking prevalence has decreased significantly over time4. Decreases in daily smoking appear to be responsible for most of the observed drop in smoking rates, since non-daily smoking has remained relatively constant at around 4%since1999.

From 1999 to 2011, the average annual decrease inprevalencewas3.2%ofthepreviousyear’svalue, so that the absolute difference between successive years is getting smaller with time5.

data SoUrCE: CANADIANTOBACCOUSEMONITORINGSURvEY(CTUMS), 2011

data SoUrCE: CTUMS, 1999-2011

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FigUrE 1.2: CURRENTSMOKINGPREvALENCE,ADULTSAGED15+,2011

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16 Tobacco Use in Canada • 2013WWW.tObaccOrepOrt.ca

demograPhiC PaTTerns in smoking PreValenCeSmoking Prevalence by SexIn2011,19.7%ofmales(2.8million)and15.0%of females (2.2 million) were current smokers (Figure 1.4). This represents a statistically significant difference6 in prevalence between the sexes. Both daily7 and non-daily8 smoking were significantly more prevalent among males than females. Between 2010 and 2011, current smoking prevalence remained constant among males9, but appeared to increase, although not significantly10, among females.Smoking rates were higher among males in all years from 1999 to 2011 (Figure 1.5).

data SoUrCE: CTUMS, 2011


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FigUrE 1.5: CURRENTSMOKINGPREvALENCEBYSEx,1999-2011

FigUrE 1.4: CURRENTSMOKINGPREvALENCEBYSEx,2011

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17Tobacco Use in Canada • 2013WWW.tObaccOrepOrt.ca

Smoking Prevalence by AgeIn 2011, smoking varied significantly by age group11: prevalence was highest among young adultsaged25-34and20-24(Figure1.6). The lowest observed prevalence was among youth aged 15-19.

A general pattern of decreasing prevalence after early adulthood appears to have held for most survey years between 1999 and 2011 (Figure 1.7). Although prevalence decreased in all age groups during this time, the largest drop was observed in the youngest age group, 15- to 19-year-olds. Notably, the older (45-54 and 55+) age groups appear to have experienced increases between 2005 and 2007, and again in 2011.

When examining differences between age groups and over time using repeat cross-sec-tional data such as this, consider that some of the differences between age groups could also be due to cohort effects (as well as age effects), in addition to changes over time.


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FigUrE 1.6: CURRENTSMOKINGPREvALENCEBYAGEGROUP,2011


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18 Tobacco Use in Canada • 2013www.tobaccoreport.ca

Smoking Prevalence by Education LevelIn 2011, there were significant differences in smoking prevalence by level of educational attainment12. Notably, university graduates had less than half the smoking prevalence of any other educational group (Figure 1.8). Educational differences were particularly large for daily smoking13,at6%foruniversitygraduates,and16-19%inothergroups;therewerenosignificantdifferences in non-daily smoking14.

At a population level, these rates represent nearly 1 million smokers with less than a secondary school education, 2 million high school graduates, 1 million college graduates, and more than 700 000 university graduates.

Since 1999, all educational groups have experienced a decline in prevalence, although patterns over time have varied. Among university graduates, who have had the lowest prevalence of smoking in all years, prevalence has steadily declined and continues to do so (Figure 1.9). While college graduates also exhibited a large and fairly steady decline in prevalence, this has reversed in the most recent years. Among those with a secondary school education or less, prevalence decreased sharply from 1999 to 2004, but has not changed substantially since then.



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FigUrE 1.8: CURRENTSMOKINGPREvALENCEBY EDUCATIONAL ATTAINMENT, 2011

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FigUrE 1.10: AvERAGEDAILYCIGARETTECONSUMPTION*,OvERALLANDBYSEx,1999-2011

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1.3 CigarEttE ConSUmPtionIn 2011, average cigarette consumption among daily smokers was 14.4 cigarettes per day (CPD), which was not significantly different from the 2010 rate of 15.1 CPD15. From 1999 to 2011, cigarette consumption declined significantly, by 3 cigarettes per day (Figure 1.10). The average rate of decline incigaretteconsumptionduringthistimeperiodwas1.4%peryear.Thereisevidencethatthediffer-ence between successive years is getting smaller with time17.

demograPhiC PaTTerns in CigareTTe ConsUmPTion

Cigarette Consumption by SexIn 2011, average daily cigarette consumption was 15.2 for male smokers and 13.3 for female smokers, a statistically significant difference18. During the time period from 1999 to 2011, sex differences appear to have remained relatively stable: males smoked, on average, about 3 cigarettes more per day than females, although this varied somewhat from year to year, and decreased to about 2 CPD in 2011 (Figure 1.10).


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Cigarette Consumption by AgeIn 2011, average daily cigarette consumption varied significantly between age groups19. Consumption was lowest among the youngest age groups, at less than 12 cigarettes per day (CPD) for smokers under 35, and appeared to increase with age, before dropping slightly among those over 55 (Figure 1.11).

The same general pattern of increasing consumption with age and a slight drop after 55 held for most years between 1999 and 2010, although with some variation (Figure 1.12). Between 1999 and 2011, average daily cigarette consumption appears to have decreased overall in all age groups, although least among the youngest smokers.


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Cigarette Consumption by Education LevelAverage daily cigarette consumption varied between educational groups in 201120.Consumptionwashighest(at16.2CPD) among daily smokers with less than a secondary school education, and decreased with increasing educational attainment to a low of 12.5 CPD for university graduates (Figure 1.13).

When considering all survey years from 1999 to 2011, university graduates generally smoked 2-3 fewer cigarettes per day than those with the lowest level of education, although there was some year-to-year variation.

Between 1999 and 2011, daily cigarette consumption appears to have decreased in all educational groups, although not steadily, particularly among university graduates (Figure 1.14). The pattern of lower consumption with increasing education generally held over time, with some variation.


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2. Smoking in thE ProvinCESsmoking PreValenCe By ProVinCeIn 2011, there was significant variation in smoking prevalence by province21 (Figure 2.1). Current smoking ratesrangedfromalowof14.2%inBritishColumbiatoahighof19.8%inQuebec.Twoprovinces,OntarioandBritishColumbia,hadsmokingratesbelowthenationalaverageof17.3%.

Between 1999 and 2011, smoking prevalence decreased substantially in all provinces, although not consistently (Table 2.1). There was considerable variation by province in the magnitude of this decline: from more than 10percentagepointsinQuebecto less than 5 in Manitoba. Several provinces appear to have reached a plateau in smoking prevalence, or even experienced a slight rise, in the most recent years. Throughout this time period, British Columbia consistently had the lowest smoking rate of all provinces.

*INCLUDES DAILY AND NON-DAILY SMOKERS data SoUrCE: CTUMS, 1999-2011

tablE 2.1: SMOKINGPREvALENCE*BYPROvINCE,1999-2011

*INCLUDES DAILY AND NON-DAILY SMOKERS data SoUrCE: CTUMS, 2011

FigUrE 2.1: SMOKINGPREvALENCE*BYPROvINCE,2011

YEar 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Canada 25.2 24.4 21.7 21.4 20.9 19.6 18.7 18.6 19.2 17.9 17.5 16.7 17.3

BRITISH COLUMBIA 20.0 19.6 16.7 16.5 16.4 15.2 14.7 16.4 14.4 14.7 14.9 14.3 14.2

ALBERTA 26.0 22.6 25.1 22.8 20.0 20.1 20.6 21.3 21.0 20.4 18.0 18.8 17.7

SASKATCHEWAN 25.9 28.1 25.4 21.2 24.1 21.7 22.0 23.7 24.0 20.4 22.3 21.1 19.2

MANITOBA 23.3 25.7 25.9 21.1 20.9 20.6 22.3 20.1 19.9 20.8 18.9 20.5 18.7

ONTARIO 23.2 23.1 19.7 19.7 19.6 18.7 16.4 16.6 18.3 16.8 15.4 15.2 16.3

QUEBEC 30.3 28.2 24.1 25.8 24.6 22.2 22.2 20.1 21.7 19.1 20.7 17.8 19.8

NEW BRUNSWICK 26.5 26.6 25.0 21.1 24.3 24.2 21.8 22.6 21.2 19.9 21.3 19.3 18.8

NOVA SCOTIA 28.9 29.8 24.9 25.3 22.1 20.2 21.0 21.8 20.4 19.7 19.8 20.8 18.1

PRINCE EDWARD ISLAND 25.6 25.7 25.6 23.1 21.4 21.2 19.9 19.2 18.4 19.2 17.7 16.2 19.1

NFLD. & LABRADOR 28.5 27.7 25.7 24.1 23.0 21.8 20.6 21.7 21.2 20.2 20.7 20.0 19.0

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CigareTTe ConsUmPTion By ProVinCeIn 2011, the variation by province in average daily cigarette consumption was not statistically significant 22 (Figure2.2).AverageCPDrangedfrom13.6cigarettesinOntarioto16.3inNewBrunswick.

Between 1999 and 2011, average daily cigarette consumption appears to have decreased in all provinces, although with a plateau in the most recent years for most provinces (Table 2.2). The magnitude of this decline varied somewhat by province, with the greatest decreaseobservedinQuebec(from 19.1 to 15.4 CPD).

*AMONGDAILYSMOKERSdata SoUrCE: CTUMS, 1999-2011

tablE 2.2: AvERAGEDAILYCIGARETTECONSUMPTION*BYPROvINCE,1999-2011

*AMONGDAILYSMOKERS data SoUrCE: CTUMS, 2011

FigUrE 2.2: AvERAGEDAILYCIGARETTECONSUMPTION*BYPROVINCE, 2011

YEar 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Canada 17.4 16.8 16.2 16.4 15.9 15.2 15.7 15.5 15.5 14.9 14.5 15.1 14.4


ALBERTA 16.2 16.6 16.3 16.4 14.6 14.4 14.9 15.9 16.1 14.2 13.9 14.9 13.9

SASKATCHEWAN 16.0 15.3 16.1 16.1 16.0 13.9 14.1 14.6 13.9 14.8 14.4 15.4 14.8

MANITOBA 15.8 16.7 14.8 15.7 14.7 14.9 14.1 14.0 14.1 13.6 12.9 13.3 14.4

ONTARIO 16.6 16.9 15.5 15.5 15.5 15.4 15.6 15.4 15.5 15.5 14.2 15.0 13.6

QUEBEC 19.1 17.6 17.3 17.6 16.8 15.5 16.5 15.6 15.8 14.9 15.4 15.1 15.4

NEW BRUNSWICK 18.3 19.0 17.6 16.2 16.3 16.7 16.9 15.3 17.3 15.5 16.1 17.4 16.3

NOVA SCOTIA 18.1 17.7 15.3 17.4 15.1 14.9 15.5 16.4 15.2 15.5 15.1 16.7 15.3


NFLD. & LABRADOR 17.2 15.5 16.7 16.2 16.1 14.6 15.5 16.0 14.1 14.1 15.4 14.5 14.5

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2.1 britiSh ColUmbiasmoking PreValenCeIn 2011, smoking prevalence inBritishColumbiawas14.2%,well below the national average of17.3%.

Figure 2.3 (below) shows smoking prevalence, overall and by sex, in British Columbia from 1999-2011. Overall, prevalence declined until around 2004 and has remained fairly stable since then. Males had similar or greater prevalence than females in all years observed, although there was some year-to-year variation.

britiSh ColUmbia in 2011

Smoking prevalence: 14.2% (548 000 smokers) ➤ comparedto14.3%in2010

• Males: 17.6%(334000smokers) • Females: 11.0%(214000smokers)

average daily cigarette consumption: 14.1 CPd ➤ compared to 13.4 CPD in 2010

• Males: 15.9 CPD• Females: 10.9 CPD

average price per cartonv (200 cig.): $93.23

Figure 2.4 (next page) shows smoking prevalence by age group in British Columbia, from 1999-2011. During this time, smoking prevalence decreased (although not consistently) in all age groups exceptthoseover45,forwhomsmokingprevalencefluctuatedaround11-14%forthistimeperiod.Prevalence has not decreased in the past few years among most age groups.


FigUrE 2.3:CURRENTSMOKINGPREvALENCE*BYSEx,BRITISHCOLUMBIA,1999-2011

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CigareTTe ConsUmPTionBetween 1999 and 2011, average daily cigarette consumption in British Columbia has fluctuated around 15 (Figure 2.5). Cigarette consumption was higher among males than females in all years, but with a considerable amount of year-to-year variation.



FigUrE 2.5:AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,BRITISHCOLUMBIA,1999-2011

FigUrE 2.4:CURRENTSMOKINGPREvALENCE*BYAGEGROUP,BRITISHCOLUMBIA,1999-2011

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2.2 albErtasmoking PreValenCeIn 2011, smoking prevalence inAlbertawas17.7%,justslightly above the national averageof17.3%.

Figure2.6(below)showssmoking prevalence, overall and by sex, in Alberta from 1999-2011. Prevalence has declined overall, but progress appears to have slowed after 2003. Males had similar or greater prevalence than females in all but one of the years observed.

Figure 2.7 (next page) shows smoking prevalence by age group in Alberta, from 1999-2011. During this time, smoking prevalence decreased substantially in all age groups except those over45,forwhomsmokingprevalenceremainedbetween15and20%inmostyears.


FigUrE 2.6:CURRENTSMOKINGPREvALENCE*BYSEx,ALBERTA,1999-2011

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albErta in 2011Smoking prevalence: 17.7% (539 000 smokers) ➤ comparedto18.8%in2010

• Males: 20.1%(314000smokers)• Females: 15.1%(225000smokers)


• Males: 15.5 CPD • Females: 11.5 CPD





FigUrE 2.7:CURRENTSMOKINGPREvALENCE*BYAGEGROUP,ALBERTA,1999-201119

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CigareTTe ConsUmPTionBetween 1999 and 2011, average daily cigarette consumption in Alberta fluctuated around 15 but appears to have decreased overall (Figure 2.8). Male smokers consistently consumed 3-4 cigarettes more per day than female smokers.


FigUrE 2.8:AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,ALBERTA,1999-2011

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2.3 SaSkatChEwansmoking PreValenCeIn 2011, smoking prevalence in Saskatchewanwas19.2%,abovethenationalaverageof17.3%.

Figure 2.9 (below) shows smoking prevalence, overall and by sex, in Saskatchewan from 1999-2011. Despite considerable year-to-year variation during this time, there appears to have been a net decrease in overall prevalence and a recent downward trend. Prevalence was similar for males and females, or slightly greater among males, particularly in the most recent years.

Figure 2.10 (next page) shows smoking prevalence by age group in Saskatchewan, from 1999-2011. Although smoking rates fluctuated considerably, prevalence was lower in 2011 than in 1999 among all age groups, and most exhibited a downward trend over time, with the exception of those over 45.


FigUrE 2.9:CURRENTSMOKINGPREvALENCE*BYSEx,SASKATCHEWAN,1999-2011

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SaSkatChEwan in 2011

Smoking prevalence: 19.2%(162000smokers)➤ comparedto21.1%in2010



• Males:16.7CPD• Females: 12.1 CPD

average price per cartonv(200cig.):$97.06



CigareTTe ConsUmPTionBetween 1999 and 2011, average daily cigarette consumption in Saskatchewan appears to have decreased slightly, but then increased again to remain around 15 (Figure 2.11). Male smokers consumed considerably more cigarettes per day than female smokers in all years.



FigUrE 2.11:AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,SASKATCHEWAN,1999-2011

FigUrE 2.10:CURRENTSMOKINGPREvALENCE*BYAGEGROUP,SASKATCHEWAN,1999-2011

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2.4 manitobasmoking PreValenCeIn 2011, smoking prevalence in Manitobawas18.7%,abovethenationalaverageof17.3%.

Figure 2.12 (below) shows smoking prevalence, overall and by sex, in Manitoba from 1999-2011. During this time, prevalence showed a net decrease, although it has not changed considerably since 2002. Prevalence was similar or greater among males than females in all years observed, although there was some variation from year to year.

Figure 2.13 (next page) shows smoking prevalence by age group in Manitoba, from 1999-2011. During this time, smoking prevalence decreased in all age groups except those over 45, for whom smoking prevalence fluctuated in the mid-teens. The largest decrease observed was among those aged 15-19 years, for whom prevalence nearly halved over this time period.


FigUrE 2.12:CURRENTSMOKINGPREvALENCE*BYSEx,MANITOBA,1999-2011

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manitoba in 2011

Smoking prevalence: 18.7% (187 000 smokers)➤ comparedto20.5%in2010

• Males:21.5%(107000smokers)• Females:15.8%(80000smokers)


• Males: 15.5 CPD • Females: 12.6CPD




CigareTTe ConsUmPTionBetween 1999 and 2011, average daily cigarette consumption in Manitoba appears to have decreased slowly, but with little change in recent years (Figure 2.14). Male smokers consumed more cigarettes per day than female smokers in all years, although the magnitude of sex differences varied by year.



FigUrE 2.14:AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,MANITOBA,1999-2011

FigUrE 2.13:CURRENTSMOKINGPREvALENCE*BYAGEGROUP,MANITOBA,1999-2011

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2.5 ontariosmoking PreValenCeIn 2011, smoking prevalence in Ontariowas16.3%,anditwasoneofjusttwoprovincesbelowthenationalaverageof17.3%.

Figure 2.15 (below) shows smoking prevalence, overall and by sex, in Ontario from 1999-2011. Overall prevalence appears to have declined slowly until 2005, and remained fairly stable since. Prevalence was greater among males than females in all years observed; however, the magnitude of this difference varied considerably from year to year, from similar rates to a difference of 10 percentage points.

Figure2.16(nextpage)showssmokingprevalencebyagegroupinOntario,from1999-2011.Duringthis time period, smoking prevalence decreased substantially in all age groups except those over 45, forwhomsmokingprevalencefluctuatedaround15%.Thisdecreasewasparticularlylargeamongthose aged 15-19 years, for whom prevalence went from 1 in 4 to less than 1 in 10 over this time.


FigUrE 2.15:CURRENTSMOKINGPREvALENCE*BYSEx,ONTARIO,1999-2011

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ontario in 2011

Smoking prevalence: 16.3%(1796000smokers) ➤ comparedto15.2%in2010

• Males: 19.0 (1 024 000 smokers)• Females: 13.8%(773000smokers)


• Males: 14.1 CPD• Females: 12.8 CPD




CigareTTe ConsUmPTionBetween 1999 and 2011, average daily cigarette consumption in Ontario remained fairly stable, and appears to have decreased in recent years (Figure 2.17). Cigarette consumption was higher among male smokers than females in all years, although the magnitude of sex differences varied over time.



FigUrE 2.17:AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,ONTARIO,1999-2011

FigUrE 2.16:CURRENTSMOKINGPREvALENCE*BYAGEGROUP,ONTARIO,1999-2011

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2.6 QUEbECsmoking PreValenCeIn 2011, smoking prevalence in Quebecwas19.8%,abovethenationalaverageof17.3%,andthehighest among all provinces.

Figure 2.18 (below) shows smoking prevalence, overall and by sex, in Quebecfrom1999-2011.Duringthis time, prevalence declined fairly steadily, and more steeply than in other provinces, although recent years have seen little progress. Prevalence was similar among males and females in most years, although males had higher smoking rates in some instances.

Figure2.19(nextpage)showssmokingprevalencebyagegroupinQuebec,from1999-2011. Smoking prevalence decreased in all age groups during this time; most notably, prevalence among 15- to 19-year-olds decreased by half.


FigUrE 2.18:CURRENTSMOKINGPREvALENCE*BYSEx,QUEBEC,1999-2011

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Smoking prevalence: 19.8% (1 312 000 smokers)➤ comparedto17.8%in2010







CigareTTe ConsUmPTionBetween1999and2011,averagedailycigaretteconsumptioninQuebecdecreasedby4cigarettesper day (Figure 2.20). During this time period, male smokers generally consumed 2-4 cigarettes more per day than female smokers, although they were similar in some years, including 2011.



FigUrE 2.20:AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,QUEBEC,1999-2011

FigUrE 2.19:CURRENTSMOKINGPREvALENCE*BYAGEGROUP,QUEBEC,1999-2011

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2.7 nEw brUnSwiCksmoking PreValenCeIn 2011, smoking prevalence in NewBrunswickwas18.8%,abovethenationalaverageof17.3%.

Figure 2.21 (below) shows smoking prevalence, overall and by sex, in New Brunswick from 1999-2011. During this time, although prevalence fluctuated, it decreased overall. Prevalence was greater among males than females in all years, although there was some variation from year to year in the magnitude of this difference.

Figure 2.22 (next page) shows smoking prevalence by age group in New Brunswick, from 1999-2011. During this time period, smoking prevalence decreased in all age groups; the largest decrease was among those aged 15-19, whose smoking rate halved.


FigUrE 2.21:CURRENTSMOKINGPREvALENCE*BYSEx,NEWBRUNSWICK,1999-2011

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nEw brUnSwiCk in 2011


• Males:21.7%(67000smokers)• Females: 16.0%(52000smokers)


• Males: 18.6CPD• Females: 13.3 CPD




CigareTTe ConsUmPTionAverage daily cigarette consumption in New Brunswick appears to have decreased between 1999 and2006,beforereachingstabilityandevenincreasinginthemostrecentyears(Figure2.23).Male smokers consumed considerably more cigarettes per day than female smokers in all years.



FigUrE 2.23:AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,NEWBRUNSWICK,1999-2011

FigUrE 2.22:CURRENTSMOKINGPREvALENCE*BYAGEGROUP,NEWBRUNSWICK,1999-2011

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2.8 nova SCotiasmoking PreValenCeIn 2011, smoking prevalence in NovaScotiawas18.1%,abovethenationalaverageof17.3%.

Figure 2.24 (below) shows smoking prevalence, overall and by sex, in Nova Scotia from 1999-2011. Prevalence decreased fairly steadily and steeply for the first half of the decade, before reaching aplateauaround20%andfurtherdecreasing in the last year. Prevalence was greater among males than females in all years observed, although only slightly in several cases.

Figure 2.25 (next page) shows smoking prevalence by age group in Nova Scotia, from 1999-2011. During this time period, smoking prevalence decreased substantially, although not steadily, in all age groups. The largest decrease observed was among those aged 15-19, for whom smoking was reduced by more than half.


FigUrE 2.24:CURRENTSMOKINGPREvALENCE*BYSEx,NOvASCOTIA,1999-2011

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CU

rr

en

T s

mo

kin

g (

%)

year

nova SCotia in 2011



average daily cigarette consumption: 15.3 CPd ➤ comparedto16.7CPDin2010





CigareTTe ConsUmPTionBetween 1999 and 2011, average daily cigarette consumption in Nova Scotia appears to have decreasedoverall,althoughlittlechangehasbeenobservedsince2003(Figure2.26).Malesmokers consumed more cigarettes per day than female smokers in all years, with some variation.



FigUrE 2.26:AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,NOvASCOTIA,1999-2011

FigUrE 2.25:CURRENTSMOKINGPREvALENCE*BYAGEGROUP,NOvASCOTIA,1999-2011

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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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%)

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me

an

CP

d

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i: adUltS smoking

in The ProVinCes


2.9 PrinCE Edward iSland

smoking PreValenCeIn 2011, smoking prevalence in PrinceEdwardIslandwas19.1%,abovethenationalaverageof17.3%.

Figure 2.27 (below) shows smoking prevalence, overall and by sex, in Prince Edward Island from 1999-2011. Prevalence decreased slowly but steadily until 2010, and was consistently higher among males than females. However, there appears to have been an uptick in prevalence for the most recent year, among both males and females.

Figure 2.28 (next page) shows smoking prevalence by age group in Prince Edward Island, from 1999-2011. During this time period, smoking prevalence decreased in all age groups. The largest decrease observed was among those aged 15-19, whose smoking rate dropped by nearly half during this time period. Prevalence appears to have increased between 2010 and 2011, particularly among 20- to 24-year-olds, although it is not clear whether this is an anomaly or the beginning of an upward trend.


FigUrE 2.27:CURRENTSMOKINGPREvALENCE*BYSEx,PRINCEEDWARDISLAND,1999-2011

0

5

10

15

20

25

30

35

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

■ PRINCE EDWARD ISLAND ■ MALE ■ FEMALE

CU

rr

en

T s

mo

kin

g (

%)

year

PrinCE Edward iSland in 2011








CigareTTe ConsUmPTionAverage daily cigarette consumption in Prince Edward Island appears to have decreased fairly steadilyfrom1999to2006,andfluctuatedaroundjustover15CPDsincethen(Figure2.29). Male smokers consistently consumed roughly 3-5 more cigarettes per day than female smokers.



FigUrE 2.29:AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,PRINCEEDWARDISLAND,1999-2011

FigUrE 2.28:CURRENTSMOKINGPREvALENCE*BYAGEGROUP,PRINCEEDWARDISLAND,1999-2011

0

5

10

15

20

25

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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%)

age groUP

me

an

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d

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i: adUltS smoking

in The ProVinCes


2.10 nEwFoUndland & labrador

smoking PreValenCeIn 2011, smoking prevalence in Newfoundland & Labrador was 19.0%,abovethenationalaverageof17.3%.

Figure 2.30 (below) shows smoking prevalence, overall and by sex, in Newfoundland and Labrador from 1999-2011. Overall prevalence declined fairly steeply and steadily until 2005, and has fluctuatedaround20%since.Thisgeneral pattern was observed for both males and females, although prevalence was higher among males in all years.

Figure 2.31 (next page) shows smoking prevalence by age group in Newfoundland & Labrador, from 1999-2011. During this time period, smoking prevalence decreased in all age groups, although only slightly among those over 45. The largest decrease observed was among those aged 15-19, whose smoking rate dropped by more than half.


FigUrE 2.30:CURRENTSMOKINGPREvALENCE*BYSEx,NEWFOUNDLAND&LABRADOR,1999-2011

0

5

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25

30

35

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

■ NEWFOUNDLAND & LABRADOR ■ MALE ■ FEMALE

CU

rr

en

T s

mo

kin

g (

%)

year

nEwFoUndland & labrador in 2011


• Males: 21.0%(44000smokers)• Females:17.0%(37000smokers)






CigareTTe ConsUmPTionBetween 1999 and 2011, average daily cigarette consumption in Newfoundland & Labrador has fluctuated, but appears to have decreased overall (Figure 2.32). Male smokers consumed considerably more cigarettes per day than female smokers in all years.



FigUrE 2.32:AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,NEWFOUNDLAND&LABRADOR,1999-2011

FigUrE 2.31:CURRENTSMOKINGPREvALENCE*BYAGEGROUP,NEWFOUNDLAND&LABRADOR,1999-2011

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25

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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i: adUltSCigareTTe

soUrCes and PUrChasing


3. CigarEttE SoUrCES and PUrChaSingUsUal soUrCes oF CigareTTesWhensmokerswereaskedwheretheyusuallygottheircigarettes,thevastmajoritypurchased them for themselves, most often from a small grocery or convenience store or gas station (Figure3.1).Notably,4.0%ofsmokersstatedtheirusualsourceofcigarettesasaFirstNationsreserve (either on-site or delivery service).

ConTraBand and CheaPer CigareTTesSmokers are price-sensitive, and may seek ways to purchase cheaper cigarettes, particularly as tobacco taxes increase the overall price of cigarettes. One such source is purchasing contraband cigarettes.Contrabandis“anytobaccoproductthatdoesnotcomplywiththeprovisionsofall applicable federal and provincial statutes. This includes importation, stamping, marking, manufacturing, distributing and payment of duties and taxes”vi, p.12. The RCMP has identified the tradeincontrabandasa“seriousthreattopublicsafetyandhealth”vi, p. 15. The federal government has also recently made contraband a priority issue for tobacco control in Canada, and the Minister of Public Safety created a Task Force on Illicit Tobacco Products in 2008 to deal with the issuevii.

Some of the sources of purchase reported in the next section may include contraband, where appropriate taxation has been evaded, while others represent the efforts of smokers to legally obtain cheaper cigarettes.


FigUrE 3.1:PERCENTAGEOFSMOKERSWHOUSUALLYGOTCIGARETTESFROMvARIOUSSOURCES,2011

BUY FROM SUPERMARKET,7.1%

BUYFROMGASSTATION,20.5%

BUYFROMSMALLGROCERY/CONvENIENCESTORE,53.8%

BUY FROM ANOTHER KINDOFSTORE,6.4%

BUY FROM FIRST NATIONS RESERvE,4.0%

FREE FROM FRIEND/FAMILY/SOMEONEELSE,3.5%

OTHERSOURCES,4.7%

i: adUltSCigareTTe soUrCes and PUrChasing


PUrChasing CigareTTes – soUrCesSmokerswereaskedaboutvarioussourcesofpurchaseusedinthepast6months(Figure3.2),andalso about the proportion of their cigarettes purchased from each of the sources they had utilized.

data SoUrCE: CTUMS, 2011*NOTE: SMOKERS COULD INDICATE MULTIPLE SOURCES, SO THESE ESTIMATES SHOULD NOT BE ADDED

FigUrE 3.2:PERCENTAGEOFSMOKERSWHOHADPURCHASED(ANY)CIGARETTESFROMvARIOUSSOURCESINTHEPAST6MONTHS,2011

0 10 20 30 40 50 60 70 80 90 100

OTHER

SMUGGLED

FIRST NATIONS RESERVE

STORE

Purchasing from Stores & Discount CigarettesThemajorityofsmokersreportedhavingpur-chasedfromastoreorgasstationinthepast6months. Of those who purchased from a store, most(84.6%)purchasedalloftheircigarettesfrom a store.

Purchasing cheaper brands of cigarettes is one way that smokers may minimize costs. Respondents who had purchased from a store were asked what percentage of all the cigarettes boughtfromastoreinthepast6monthswerediscountbrandcigarettes(“brand-name cigarettes manufactured by a multinational company and sold at a lower-than-average price”) and full-priced, premium brand cigarettes (“brand-name cigarettes manufactured by a multinational company and sold at average or higher-than average prices”). More than half (53.6%)hadpurchasedadiscountbrand,most(81.0%)ofwhompurchasedadiscountbrandforatleasthalfoftheircigarettes;31.5%ofallthosewho purchased from a store purchased only discountbrandsinthepast6months.Ontheotherhand,46.7%ofallthosewhopurchased

from a store purchased only premium cigarettes, withtheremainder(21.8%)purchasingamixofpremium and discount brands.

Purchasing from First Nations Ofthe11.3%ofsmokerswhoreportedpurchas-ingfromareserve,60.8%reportedpurchasingatleasthalfoftheircigarettesfromareserve,21.3%purchasing all of their cigarettes there.

Purchasing Smuggled CigarettesOfthe3.3%ofsmokerswhoreportedpurchasingcigarettesthatmayhavebeensmuggled*,49.0%reported that at least half of the cigarettes they purchasedinthepast6monthsmayhavebeensmuggled. Regarding ease of access for those who had purchased smuggled cigarettes, two-thirds(66.7%)saidthatitwas“veryeasy”tobuysmuggledcigarettesandanother31.2%saiditwas“easy”.

*DefinedinCTUMSas:“Smuggledcigarettesincludepur-chased cigarettes that were not manufactured on a First Nations Reserve, were not manufactured in Canada, do not contain a government of Canada Health Warning message and do not carry a tax stamp. Legally imported cigarettes are not smuggled cigarettes.”

% oF smokers PUrChasing From eaCh soUrCe*

soUrCe

PURCHASED ANY DISCOUNT BRAND PURCHASED ONLY PREMIUM BRANDS

i: adUltSUse oF oTher

ToBaCCo ProdUCTs


Cigarillos (little cigars) were the most popular tobacco product other than cigarettes,with2.6%ofCanadiansreporting use in the past 30 days (Figure 4.1). Cigar use was reported by1.3%ofrespondents.Waterpipe (also called hookah or shisha) was askedaboutin2011,with0.8%reporting use. Pipe and chewing tobacco/pinch/snuff use were lesscommon,usedby0.5%ofrespondents or less (Figure 4.1).

After regular increases between 1999 and 2008, use of cigars/cigarillos appears to be on the decline. Use of chewing tobacco/pinch/snuff and smoking a pipe have both remained fairly low and stable over time (Figure 4.2).

4. USE oF othEr tobaCCo ProdUCtS 4.1 PrEvalEnCE oF USE oF othEr tobaCCo ProdUCtS

*PRIORTO2007,CIGARSANDCIGARILLOSWEREGROUPEDTOGETHERINASINGLEQUESTIONNAIREITEM;FROM2007-2011THEYWEREASKEDASTWOSEPARATE ITEMS AND COMBINED IN THE ANALYSIS**IN2000,CHEWINGTOBACCOANDPINCH/SNUFFWEREASKEDASSEPARATEQUESTIONNAIREITEMSANDCOMBINEDINTHEANALYSIS;IN2003-2011THEYWEREGROUPEDTOGETHERINASINGLEITEM data SoUrCE: CTUMS, 1999-2011

0.0

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3.5

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0

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5

6

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

FigUrE 4.2: PREVALENCE OF USE IN THE PAST 30 DAYS FOR VARIOUS TOBACCO PRODUCTS, 1999-2011

FigUrE 4.1: PREVALENCE OF USE IN THE PAST 30 DAYS FOR VARIOUS TOBACCO PRODUCTS, 2011


% o

F r

esP

on

de

nTs

% o

F r

esP

on

de

nTs

year

ProdUCTs

CIGARILLOS CIGARS PIPE CHEWINGTOBACCO/

PINCH/SNUFF

WATERPIPE

● CIGARS/CIGARILLOS*● CHEWINGTOBACCO/PINCH/SNUFF**● PIPE

i: adUltSUse oF oTher ToBaCCo ProdUCTs


Other Tobacco Use by SexFor all tobacco products, prevalence of use was significantly higher among males than females23-27. For example, in 2011, whilemorethan4%ofmaleshadsmoked a cigarillo in the last 30 days,lessthan1%offemaleshaddone so (Figure 4.3).

Over time, the use of cigars/cigarillos has changed in parallel for both males and females; gender differences have persisted over time (Figure 4.4).

demograPhiC PaTTerns in oTher ToBaCCo Use

*PRIORTO2007,CIGARSANDCIGARILLOSWEREGROUPEDTOGETHERINASINGLEQUESTIONNAIREITEM;FROM2007-2011THEYWEREASKEDASTWOSEPARATE ITEMS AND COMBINED IN THE ANALYSIS


0

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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

FigUrE 4.4: PREvALENCEOFUSEINTHEPAST30DAYSFORCIGARS/CIGARILLOS*,BYSEx,1999-2011

FigUrE 4.3: PREVALENCE OF USE IN THE PAST 30 DAYS FOR vARIOUSTOBACCOPRODUCTS,BYSEx,2011

*DATA NOT REPORTABLE DUE TO LOW NUMBERS IN THE NUMERATOR AND/OR DENOMINATORdata SoUrCE: CTUMS, 2011

% o

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% o

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on

de

nTs

year

CIGARILLOS CIGARS PIPE* *

CHEWINGTOBACCO/

PINCH/SNUFF

WATERPIPE

ProdUCTs

● MALE ● FEMALE



ToBaCCo ProdUCTs


Other Tobacco Use by AgeIn 2011, use of other tobacco products varied significantly by age group28-32

(Figure 4.5). Youth and young adults between ages 15 and 24 reported the highest prevalence of use of other tobacco products, particularly cigars and cigarillos. After young adulthood, prevalence of use appears to decrease with age for all products (Figure 4.5).

This pattern of high use among the younger age groups, declining with increasing age, applies to cigar/cigarillo use in almost all years (where data is available) between 1999and2011(Figure4.6).Inaddition,thedifference in prevalence between younger and older age groups appears to have grown over time, especially for the 20-24 age group; however, this gap seems to have decreased in the most recent years. Use of cigars/cigarillos appears to have increased over time in all groups until 2008, after which rates of use appear to be decreasing.

*PRIORTO2007,CIGARSANDCIGARILLOSWEREGROUPEDTOGETHERINASINGLEQUESTIONNAIREITEM;FROM2007-2011,THEYWEREASKEDASTWOSEPARATE ITEMS AND COMBINED IN THE ANALYSIS


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FigUrE 4.6: PREvALENCEOFUSEINTHEPAST30DAYSFORCIGARS/CIGARILLOS*,BYAGEGROUP,1999-2011

FigUrE 4.5: PREVALENCE OF USE IN THE PAST 30 DAYS FORvARIOUSTOBACCOPRODUCTS,BYAGEGROUP,2011

* DATA NOT REPORTABLE DUE TO LOW NUMBERS IN THE NUMERATOR AND/OR DENOMINATOR**AGEGROUPSOvER25HAvEBEENCOMBINEDDUETOLOWNUMBERSdata SoUrCE: CTUMS, 2011

% o

F r

esP

on

de

nTs

ProdUCTs

■ 15-19 ■ 20-24 ■ 25-44 ■ 45+

■ 15-19 ■ 20-24 ■ 25-44 ■ 45+

% o

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esP

on

de

nTs

year

CIGARILLOS CIGARS PIPE CHEWINGTOBACCO/

PINCH/SNUFF

WATERPIPE

*



Other Tobacco Use by ProvinceCigars/CigarillosPrevalence of use of cigars/cigarillos varied significantly by province33,from2.2%inPEIto4.3%inQuebecin2011(Table4.1).Pointestimatesofusefor2011werelowerthanfor2010inallprovinces.After 1999, use of cigars/cigarillos increased for a number of years before the trend reversed around 2008; rates of use have returned to near 1999 levels in about half of provinces.

tablE 4.1: PREvALENCEOFUSEINPAST30DAYSFORCIGARS/CIGARILLOS*,BYPROvINCE,1999-2011

*PRIORTO2007,CIGARSANDCIGARILLOSWEREGROUPEDTOGETHERINASINGLEQUESTIONNAIREITEM;FROM2007-2011THEYWEREASKEDASTWOSEPARATE ITEMS AND COMBINED IN THE ANALYSIS ! DATA NOT REPORTABLE DUE TO LOW NUMBERS IN THE NUMERATOR AND/OR DENOMINATOR data SoUrCE: CTUMS, 1999-2011

YEar 1999 2000 2001 2002 2003 2004 2005 2006

2007 (cigar/

cigarillo)

2008 (cigar/

cigarillo)

2009 (cigar/

cigarillo)

2010 (cigar/

cigarillo)

2011 (cigar/

cigarillo)

Canada 3.4 3.5 -- -- 3.3 3.9 4.4 4.15.1

(2.2/4.1)5.4

(2.6/4.2)4.5

(1.6/3.7)3.9

(1.4/3.1)3.4

(1.3/2.6)

BC 2.9 2.5 -- -- 3.4 3.9 3.6 5.45.4

(2.2/4.6)4.9

(2.3/3.9)5.6

(1.9/4.9)4.5

(1.9/3.6)3.2

(1.9/2.3)

AB 4.1 3.1 -- -- 4.0 4.8 5.9 5.56.9

(3.7/5.5)5.7

(2.1/4.6)5.6

(2.4/4.1)4.5

(1.8/3.5)4.2

(1.4/3.4)

SK 3.2 3.0 -- -- 4.1 4.1 4.5 4.65.6

(2.9/4.5)6.1

(3.0/5.0)6.2

(2.1/5.4)4.7

(1.4/4.2)3.8

(1.2/3.3)

MB 4.8 3.3 -- -- 3.5 4.3 4.8 3.34.2

(2.2/3.1)4.2

(2.0/3.0)5.2

(1.9/4.0)4.7

(1.6/3.9)4.0

(1.6/3.5)

ON 3.4 3.8 -- -- 2.4 3.8 3.9 3.03.5

(2.0/2.4)4.8

(2.6/3.5)3.1

(1.3/2.4)2.6

(!/2.0)2.5

(!/2.1)

PQ 3.5 3.8 -- -- 4.2 3.4 5.2 4.66.5

(1.8/5.8)6.5

(3.0/5.1)5.3

(1.3/4.5)5.0

(1.4/4.2)4.3

(1.5/3.3)

NB 3.2 3.3 -- -- 3.8 4.1 5.1 4.96.8

(2.7/5.6)7.7

(3.5/5.8)4.7

(1.1/4.1)5.0

(2.0/3.6)4.2

(2.2/2.8)

NS 3.5 3.0 -- -- 4.2 3.9 4.5 4.75.8

(2.5/4.7)5.9

(2.4/4.8)5.3

(2.4/4.0)4.9

(2.0/3.9)3.2

(1.8/1.9)

PEI 2.4 3.1 -- -- 3.0 2.4 3.8 4.13.9

(1.7/3.5)4.5

(1.5/3.9)3.8

(1.4/2.9)3.5

(1.9/2.5)2.2

(0.8/1.7)

NL 2.8 1.3 -- -- 2.0 3.4 3.0 3.94.6

(1.9/3.8)5.4

(1.7/4.3)4.2

(!/4.0)3.2

(!/2.7)2.8

(!/2.1)

Chewing ToBaCCo, PinCh and snUFFIn 2011, use of chewing tobacco/pinch/snuff in the past 30 days was too low to report in all provinces exceptSaskatchewanandAlberta:2.1%ofadultsinSaskatchewanand1.3%ofadultsinAlbertahadusedchewing tobacco, pinch or snuff in the past 30 days.

waTerPiPeIn2011,waterpipeuseinthepast30dayswastoolowtoreportinthemajorityofprovinces:0.9%ofadultsinOntario,0.7%ofadultsinQuebec,and1.3%ofadultsinAlbertahadusedawaterpipeinthepast30days.

FlaVoUred ToBaCCo ProdUCTsIn 2010, federal legislation came into effect which banned flavours (except menthol) in cigarettes, little cigars/cigarillos, and blunt wrapsviii. However, other flavoured tobacco products remain on the market. Users of other tobacco products were asked if any of the products they had used in the last 30 days were flavoured.Overall,65%ofthosewhohadusedanynon-cigarettetobaccoproductsinthelast30dayshadusedaflavouredproduct.However,thisvariedbyproduct:flavouredcigarilloswereusedby71.7%ofcigarillousers,flavouredcigarsby23.5%ofcigarusers,flavouredpipetobaccoby55.1%ofpipeusers,flavouredchewingtobacco/pinch/snuffby61.4%ofsmokelessusers,andflavouredwaterpipetobaccoby79.8%ofwaterpipeusers.


ToBaCCo ProdUCTs


In2011,9.7%ofsmokersusedroll-your-own tobacco at least someofthetime,including3.7%who used roll-your-own tobacco exclusively (Figure 4.7). Use of roll-your-own tobacco in 2011 was not significantly different from in 201034.

Although data were not available for all survey years, use of roll-your-own tobacco appeared to be lower in recent years than in the early 2000s, particularly for using roll-your-own tobacco all or most of the time (Figure 4.8).

4.2 USE oF roll-YoUr-own tobaCCo

*THEQUESTIONNAIREITEMREGARDINGROLL-YOUR-OWNTOBACCOWASNOTASKEDIN1999,OR2003-2006


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FigUrE 4.8: PREvALENCEOFROLL-YOUR-OWNTOBACCOUSEAMONGCURRENTSMOKERS,2000-2011*

FigUrE 4.7: PREVALENCE OF ROLL-YOUR-OWN TOBACCO USE AMONGCURRENTSMOKERS*,2011

*INCLUDES DAILY AND NON-DAILY SMOKERS data SoUrCE: CTUMS, 2011

NEVER,90.3%

Data not available

ALL THE TIME, 3.7%

MOST OF THE TIME,1.6%

SOMETIMES, 4.4%

■ SOMETIMES ■ MOST OF THE TIME ■ ALL THE TIME

% o

F C

Ur

re

nT

sm

ok

er

s

year



Roll-Your-Own Tobacco Use by SexAs shown in Figure 4.9, overall prevalence of roll-your-own tobacco use was significantly higher among males than females in 201035.

Although“allofthetime”useof roll-your-own tobacco was similar between males and females36,“mostofthetime”and“sometimes”usewassignificantly higher among males 37,38.

DEMOgRAPhIC PATTERNS IN ROLL-YOUR-OwN TObACCO USE

Roll-Your-Own Tobacco Use by AgeIn 2011, use of roll-your-own tobacco was not significantly different between age groups39 (Figure 4.10).

“Sometimes”useaccountedfor most of the roll-your-own use among young smokers (under 25), while older smokers used roll-your-own frequently(“all/most of the time”) more often (data not shown).

0

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6

8

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16

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20

15-19 20-24 25-34 35-44 45+

FigUrE 4.10: PREVALENCE OF ROLL-YOUR-OWN TOBACCO USE AMONGCURRENTSMOKERS,BYAGEGROUP,2011


0

2

4

6

8

10

12

14

MALES FEMALES

FigUrE 4.9: PREVALENCE OF ROLL-YOUR-OWN TOBACCO USE AMONGCURRENTSMOKERS,BYSEx,2011

someTimes

someTimesmosT oF The Time

mosT oF The Time

all oF The Timeall oF The Time


% o

F C

Ur

re

nT

sm

ok

er

s%

oF

CU

rr

en

T s

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ToBaCCo ProdUCTs


Roll-Your-Own Tobacco Use by ProvinceTable 4.2 (below) shows the percentage of smokers in each province who used roll-your-own tobacco at least sometimes. Use of roll-your-own tobacco varied significantly by province in 201140, fromlessthan10%(notreportable)ofsmokersinOntarioandQuebectonearly30%ofsmokersinPEI. Use was generally highest in the Atlantic provinces and the central prairies. This same general pattern by province/region has held over time since 2000, although overall use has declined in most provinces. Remarkably, in Newfoundland and Labrador, use of roll-your-own tobacco has dropped fromoverhalfofsmokersin2000-2002tojustaquarterofthat(12.5%)in2011.

As shown in Table 4.3, there is substantial variation by province in the taxation of roll-your-own tobacco. Taxation rates for roll-your-own tobacco are well below those for cigarettes in all provinces, and one-half or less the rate for cigarettes in eight of the ten provinces.

tablE 4.2: PREvALENCEOFROLL-YOUR-OWNTOBACCOUSEAMONGCURRENTSMOKERS,BYPROvINCE,2000-2011*

tablE 4.3: PROvINCIALANDFEDERALTAxONCIGARETTESAND ROLL-YOUR-OWN TOBACCO, AS OF APRIL 24, 2011

*THEQUESTIONNAIREITEMREGARDINGROLL-YOUR-OWNTOBACCOWASNOTASKEDIN1999,OR2003-2006! DATA NOT REPORTABLE DUE TO LOW NUMBERS IN THE NUMERATOR AND/OR DENOMINATOR data SoUrCE: CTUMS, 2000-2011

*THEFEDERALTOBACCOTAxWITHOUTGSTISINPARENTHESES;FEDERALGSTIS5%OFTHERETAILPRICE,WHICH VARIES BY PROVINCE

†EFFECTIVE JULY 1, 2010, THE NS PROVINCIAL COMPONENT OFTHEHSTINCREASEDFROM8%TO10%ANDBC/ONBEGANTO IMPLEMENT HST; FOR

NS/NL/BC/ON/NB,THETAxRATEWITHOUTHSTISINPARENTHESES

‡THERE IS NO PST ON TOBACCO PRODUCTS IN ALBERTA, QUEBEC,ANDPEI

§PROvINCIALSALESTAx(PST)ISINCLUDEDINTHERATESFORMANITOBAANDSASKATCHEWAN;THETAxRATEWITHOUT PST IS IN PARENTHESES

data SoUrCE:TAxATIONAUTHORITIES,COURTESYOFCANADIANCANCERSOCIETY;PST/HST/GSTCOMPUTATIONSBYOTRU[ASQUOTEDIN:ONTARIOTOBACCORESEARCHUNIT,TOBACCOTAxES:MONITORINGUPDATE,2011ix]

YEar 2000 2001 2002 2003-2006* 2007 2008 2009 2010 2011

Canada 16.2 15.0 17.5 -- 11.1 11.9 10.8 11.6 9.7

BRITISH COLUMBIA 15.9 17.2 15.7 -- 16.6 15.8 16.5 16.7 12.4

ALBERTA 20.3 19.4 25.4 -- 13.0 14.4 10.4 11.4 11.9

SASKATCHEWAN 26.9 31.8 32.2 -- 26.4 22.0 23.1 18.9 21.8

MANITOBA 25.0 26.9 31.7 -- 19.9 21.3 20.9 21.7 20.9

ONTARIO 7.4 ! 7.2 -- ! ! ! ! !

QUEBEC 18.8 15.2 19.9 -- ! 7.7 9.6 9.8 !

NEW BRUNSWICK 26.6 21.8 29.9 -- 24.0 24.1 16.6 21.1 20.9

NOVA SCOTIA 25.0 28.1 24.8 -- 24.2 16.2 19.3 18.4 22.2

PRINCE EDWARD ISLAND 25.1 31.2 28.2 -- 30.7 22.9 22.6 22.9 29.4

NFLD. & LABRADOR 53.9 52.3 54.2 -- 30.2 22.2 22.2 14.5 12.5

200 Cigarettes 200 roll-Your-own

(100g)

Federal* $20.94 ($17.00) $7.47 ($5.79)

BRITISH COLUMBIA† $42.32 ($37.00) $20.79 ($18.50)

ALBERTA‡ $40.00 $30.00

SASKATCHEWAN§ $46.05($42.00) $22.76($21.00)

MANITOBA§ $50.88 ($45.00) $24.00 ($2150)

ONTARIO† $29.80 ($24.70) $14.48 ($12.35)

QUéBEC‡ $21.20 $10.60

NEW BRUNSWICK† $39.84 ($34.00) $15.98 ($13.74)

NOVA SCOTIA† $51.24 ($43.04) $23.43 ($20.00)

PRINCE EDWARD ISLAND‡ $50.80 $19.30

NFLD. & LABRADOR† $44.16($38.00) $35.70 ($32.00)


Section ii: Quitting Smoking

highlighTsthe majority of Canadians who have ever been smokers have now quit. (p.54)

nearly two-thirds of smokers were seriously considering quitting in the next 6 months; 31%wereconsideringquittinginthenextmonth.(p. 57)

•Similarpercentagesofmalesandfemaleswereseriouslyconsideringquitting.(p. 58)

•Intentionstoquitdifferedbyagegroup,with more younger adults (aged 25-34) seriouslyconsideringquitting.(p. 59)

nearly half of smokers tried to quit in the past year. Many tried more than once. (p. 60)

•Similarpercentagesofmalesandfemaleshadmadeaquitattempt.(p. 61)

•Greaterpercentagesofyoungersmokersreportedaquitattempt.(p. 62)

Amongrespondentswhohadmadeaquitattempt in the past year, around one in ten were still abstinent from smoking at the time they were surveyed. (p. 63)

The most common strategy for trying to quitsmokingwasto“reducethenumberofcigarettessmoked,”usedby65%ofsmokerswhoattemptedtoquit.(p. 66)

nearly six out of ten smokers who attempted to quit used some form of cessation assistance. (p. 66)

•Themostcommonlyusedformofcessationassistance was nicotine replacement therapy (NRT),usedby35%ofthosewhoattemptedtoquit.

•22%ofsmokers“madeadealwithafriendorfamilymembertoquittogether.”

•Fewsmokers(<5%)usedservicessuchastelephonequitlinesorworkplaceprograms.

Stop-smoking medications, including nrt, were used by nearly half (46%) of those who attempted to quit, but use varied by product and by province. (p. 67)

More than six out of ten smokers who visited a doctor in the past year had received advice to quit.(p. 68)

ii: QUittingQUiTTer

PerCenTage


5. QUitting bEhavioUrS and oUtComES5.1 QUittEr PErCEntagEThemajority(59%)ofCanadianswhohaveeverbeensmokershavenowquit.Figure5.1(below)shows the percentage of respondents who have ever smoked, including both current and former smokers,aswellasquitterpercentage(thepercentageofeversmokerswhowereformersmokersatthetimeofsurvey)overtime.Quitterpercentageincreasedbetween1999and2005,butappearstohavereachedaplateauataround60%.

*QUITTERPERCENTAGEISCALCULATEDASTHEPERCENTAGEOFEvERSMOKERSWHOWEREFORMERSMOKERSATTIMEOFSURvEYdata SoUrCE: CTUMS, 1999-2011

50.1% 51.5% 52.3% 53.9% 55.9% 56.6% 59.7% 59.3% 59.3% 61.6% 60.5% 61.2% 59.4%

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%OFEvERSMOKERSW

HOHAvEQUIT

ThemajorityofCanadianswhohaveeverbeensmokershavenowquit.

% o

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FigUrE 5.1: PERCENTAGEOFRESPONDENTSWHOHAvEEvERSMOKED(CURRENTANDFORMERSMOKERS),ANDQUITTERPERCENTAGE*,1999-2011

ii: QUittingQUiTTer PerCenTage


Quitter Percentage by SexIn 2011, males and females had similar quitterpercentages41,at57.9%and61.3%,respectively.However,agreaterpercentage of males had ever smoked42, and were current smokers43 (Figure 5.2).

Since 1999, similar patterns have been observed; while male smoking rates (both current and ever) were higher, similar percentages of both male and femaleever-smokershadquit (Figure 5.3; Figure 5.4).

Quitterpercentagesamongbothmalesand females rose steadily between 1999 and 2005, after which point they have changed very little (Figure 5.3; Figure 5.4).

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FigUrE 5.2: PERCENTAGEOFRESPONDENTSWHOHAVE EVER SMOKED (CURRENT AND FORMER SMOKERS),ANDQUITTERPERCENTAGE*,BYSEx,2011

FigUrE 5.3: PERCENTAGEOFMALESWHOHAvEEVER SMOKED (CURRENT AND FORMER SMOKERS), ANDQUITTERPERCENTAGE*,1999-2011

FigUrE 5.4: PERCENTAGEOFFEMALESWHOHAvEEVER SMOKED (CURRENT AND FORMER SMOKERS), ANDQUITTERPERCENTAGE*,1999-2011

*QUITTERPERCENTAGEISCALCULATEDASTHEPERCENTAGEOFEvERSMOKERSWHO WERE FORMER SMOKERS AT TIME OF SURVEYdata SoUrCE: CTUMS, 2011

*QUITTERPERCENTAGEISCALCULATEDASTHEPERCENTAGEOFEvERSMOKERS WHO WERE FORMER SMOKERS AT TIME OF SURVEY


*QUITTERPERCENTAGEISCALCULATEDASTHEPERCENTAGEOFEvERSMOKERS WHO WERE FORMER SMOKERS AT TIME OF SURVEY


%OFEvERSMOKERSW

HOHAvEQUIT

%OFEvERSMOKERSW

HOHAvEQUIT

■ FORMER SMOKER ■ CURRENT SMOKER ■ FORMER SMOKER ■ CURRENT SMOKER

% o

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58% QUIT

Former smoker

CUrrenT smoker CUrrenT

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ii: QUittingQUiTTer

PerCenTage


Quitter Percentage by AgeQuitterpercentagevariedsignificantlyby age group44, increasing dramatically with increasing age, as expected given that older smokers have had more years to become former smokers. In 2011, while just17%ofever-smokersaged15-19wereformersmokerswhensurveyed,70%ofever-smokersoverage45hadquit(Figure 5.5).

Thesamepatternofincreasingquitterpercentage with age was observed in all yearssince1999(Figure5.6).Between1999and2011,quitterpercentagesappearto have generally increased among smokersoverage25.Quitterpercentageswere lower and more variable among younger smokers.

*QUITTERPERCENTAGEISCALCULATEDASTHEPERCENTAGEOFEVER SMOKERS WHO WERE FORMER SMOKERS AT TIME OF SURVEY


*QUITTERPERCENTAGEISCALCULATEDASTHEPERCENTAGEOFEvERSMOKERSWHOWEREFORMERSMOKERSATTIMEOFSURvEY data SoUrCE: CTUMS, 1999-2011

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FigUrE 5.6: QUITTERPERCENTAGEAMONGEvERSMOKERS*,BYAGEGROUP,1999-2011

FigUrE 5.5: QUITTERPERCENTAGEAMONGEvERSMOKERS,BYAGEGROUP,2011

age groUP

age groUP

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ii: QUittingQUiT inTenTions


5.2 QUit intEntionSIn2011,themajority(65.8%)ofsmokers wereseriouslyconsideringquittinginthenext6months(Figure5.7).Ofthose,nearlyhalf(47.9%)wereconsideringquittingwithinthenext30days,whichwasequivalentto30.9%ofallcurrentsmokers.

Between 2010 and 2011, the percentage of smokersseriouslyconsideringquittinginthenext6monthsincreasedsignificantly45, and while the percentage seriously considering quittinginthenext30daysappearedtoincrease as well, this difference was not significant46 among younger smokers.

Between 1999 and 2011, the percentage of smokersseriouslyconsideringquittinginthenext6monthsappearstohaveincreasedslightly. Although patterns over time were similar for the percentage seriously consideringquittinginthenext30days,there was less net change (Figure 5.8). data SoUrCE: CTUMS, 2011

* IN 1999, ONLY CYCLE 2 WAS ASKED THE RELEVANT SURVEY ITEMS. data SoUrCE: CTUMS, 1999-2011

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IN THE NEXT 6 MONTHS IN THE NEXT 30 DAYS

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FigUrE 5.8: PERCENTAGEOFSMOKERSWHOWERESERIOUSLYCONSIDERINGQUITTINGINTHENExT 6MONTHS,ANDINTHENExT30DAYS,1999*-2011

FigUrE 5.7: PERCENTAGEOFSMOKERSWHOWERESERIOUSLYCONSIDERINGQUITTINGINTHENExT 6MONTHS,ANDINTHENExT30DAYS,2011

year

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● INTHENExT6MONTHS ● INTHENExT30DAYS

ii: QUittingQUiT

inTenTions


Quit Intentions by SexIn 2011, similar percentages of males and females were seriously considering quittinginthenext6months47 and in the next 30 days48 (Figure 5.9).

Since 1999, the percentages of male and female smokers consideringquittinghavebeen similar in most years (Figure 5.10).



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FigUrE 5.10: PERCENTAGEOFSMOKERSWHOWERESERIOUSLYCONSIDERINGQUITTINGINTHENExT 6MONTHS,ANDINTHENExT30DAYS,BYSEx,1999*-2011

FigUrE 5.9: PERCENTAGEOFSMOKERSWHOWERESERIOUSLYCONSIDERINGQUITTINGINTHENExT6MONTHS,ANDINTHENExT30DAYS,BYSEx,2011

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■ MALE ■ FEMALE

● MALE-6MONTHS ● FEMALE-6MONTHS● MALE-NExT30DAYS ● FEMALE-NExT30DAYS

year

ii: QUittingQUiT inTenTions


Quit Intentions by AgeIn 2011, the percentages of smokers consideringquittinginthenext6months and in the next 30 days both differed significantly by age group49,50 (Figure 5.11). More smokers aged 25-34 were intending toquitthaninolderoryoungerage groups. Within each age group, around half of those seriously consideringquittinginthenext6monthswerealsoconsideringquittinginthenext30days.

Over time, although no clear patterns emerged among younger smokers, the percentage of smokers over 25 seriously considering quittinginthenext6monthsappeared to increase with time, although with some variation in the last few years (Figure 5.12). data SoUrCE: CTUMS, 2011


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FigUrE 5.12: PERCENTAGEOFSMOKERSWHOWERESERIOUSLYCONSIDERINGQUITTINGINTHENExT 6MONTHS,BYAGEGROUP,1999*-2011

FigUrE 5.11: PERCENTAGEOFSMOKERSWHOWERESERIOUSLYCONSIDERINGQUITTINGINTHENExT6MONTHS,ANDINTHENExT30DAYS,BYAGEGROUP,2011

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■ INTHENExT6MONTHS ■ INTHENExT30DAYS

age groUP

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ii: QUittingQUiT

aTTemPTs


5.3 QUit attEmPtSIn2011,almosthalf(45.4%)ofsmokersandrecentquittershadmadeatleastonequitattempt in the past year, and three in ten had made multiple attempts (Figure 5.13).

There was no significant change between 2010 and 2011 in the percentage of smokers and recent quitterswhohadattemptedtoquitin the past 12 months51.

The percentage of smokers and recentquitterswhohadattemptedtoquitinthepast12monthsappearsto have remained stable, at around half, from 1999 to 2011, although this appears to have decreased slightly in the most recent years (Figure 5.14). *INCLUDESCURRENTSMOKERSANDFORMERSMOKERSWHOHADQUITINTHEPAST12MONTHS


*notE:IN1999-2002,THISQUESTIONWASASKEDOFCURRENTSMOKERS;2003(DATANOTSHOWN)INCLUDEDONLYSMOKERSWHOHADTRIEDTOQUITINTHEPAST2YEARS;2004-2011INCLUDEDCURRENTSMOKERSANDFORMERSMOKERSWHOHADQUITINTHEPAST12MONTHS**IN 1999, ONLY CYCLE 2 WAS ASKED THE RELEVANT SURVEY ITEMS. data SoUrCE: CTUMS, 1999-2011

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FigUrE 5.14: PERCENTAGEOFSMOKERSANDRECENTQUITTERS*WHOATTEMPTEDTOQUITINTHEPAST12 MONTHS, 1999**-2011

FigUrE 5.13: NUMBEROFQUITATTEMPTSMADEINTHEPAST12MONTHSBYSMOKERSANDRECENTQUITTERS*,2011

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ii: QUittingQUiT aTTemPTs


Quit Attempts by SexIn 2011, the percentages of males and females who had madeaquitattemptinthepast year were not significantly different52 (Figure 5.15).

Between 2010 and 2011, the percentages of males and females who had made an attempt were similar in all years with data, and there were no notable changes over time (Figure5.16).

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FigUrE 5.15: PERCENTAGEOFSMOKERSANDRECENTQUITTERS*WHOATTEMPTEDTOQUITINTHEPAST12MONTHS,BYSEx,2011

*INCLUDESCURRENTSMOKERSANDFORMERSMOKERSWHOHADQUITINTHEPAST12MONTHSdata SoUrCE: CTUMS, 2011


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FigUrE 5.16: PERCENTAGEOFSMOKERS(ANDRECENTQUITTERS)*WHOATTEMPTEDTOQUITINTHEPAST12MONTHS,BYSEx,1999**-2011

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● MALE ● FEMALE

ii: QUittingQUiT

aTTemPTs


Quit Attempts by AgeQuitattemptsvariedsignificantlyby age group in 201153. More youngsmokershadmadeaquitattemptinthepastyear,andquitattempts appeared to decrease with age (Figure 5.17).

This pattern was consistent over time; more young smokers made aquitattemptinallyearssince1999 (Figure 5.18). Although the percentages of each age group whomadeaquitattemptvariedfrom year-to-year, there were no clear patterns of change over the last decade, except for a net decrease over time among all groups, particularly those under 25.

*INCLUDESCURRENTSMOKERSANDFORMERSMOKERSWHOHADQUITINTHEPAST12MONTHSdata SoUrCE: CTUMS, 2011


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FigUrE 5.18: PERCENTAGEOFSMOKERSANDRECENTQUITTERS*WHOATTEMPTEDTOQUITINTHEPAST12MONTHS,BYAGEGROUP,1999**-2011

FigUrE 5.17: PERCENTAGEOFSMOKERSANDRECENTQUITTERS*WHOATTEMPTEDTOQUITINTHEPAST12MONTHS,BYAGEGROUP,2011

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ii: QUittingQUiT sUCCess


5.4 QUit SUCCESS (Point abStinEnCE)In2011,ofallrespondentswhohadtriedtoquitforatleast24hoursinthepastyear(45.4%ofsmokers),10.7%werestillquitatthetimetheyweresurveyed.Thisrepresentsnosignificantchangeinquitsuccesssince201054.

Whilecomparisonfrom1999to2011isnotpossibleduetochangesinquestioncoverageandavailabilityofdata*,since2004,quitsuccessappearstohaveremainednear10-12%,withsome year-by-year fluctuation (Figure 5.19).

*IN1999-2002THISQUESTIONWASASKEDOFCURRENTSMOKERS(DATANOTSHOWN);2003INCLUDEDONLYSMOKERSWHOHADTRIEDTOQUITINTHEPAST2YEARS(DATANOTSHOWN);2004-2011ASKEDCURRENTSMOKERSANDFORMERSMOKERSWHOHADQUITINTHEPAST12MONTHSdata SoUrCE: CTUMS, 2004-2011

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FigUrE 5.19: PERCENTAGEOFCURRENTSMOKERSANDRECENTQUITTERS*WHOATTEMPTEDTOQUITINTHEPAST12MONTHSANDWERESTILLABSTINENTATTHETIMEOFSURvEY,2004-2011

Approximatelyoneintensmokerswhotriedtoquitinthelastyearwerestill abstinent from smoking when surveyed.

% o

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em

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er

s

year

ii: QUittingQUiT

sUCCess


Quit Success by SexIn 2011, females were significantly more likely than males to be abstinent from smoking at the time of survey, givenaquitattemptinthepast12 months55 (Figure 5.20).

Since 2004, success in remaining abstinent from smoking has fluctuated among both males and females, with no clear pattern emerging (Figure 5.21).

*INCLUDESCURRENTSMOKERSANDFORMERSMOKERSWHOHADQUITINTHEPAST12MONTHS data SoUrCE: CTUMS, 2011

*INCLUDESCURRENTSMOKERSANDFORMERSMOKERSWHOHADQUITINTHEPAST12MONTHSdata SoUrCE: CTUMS, 2004-2011

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FigUrE 5.21: PERCENTAGEOFCURRENTSMOKERSANDRECENTQUITTERS*WHOATTEMPTEDTOQUITINTHEPAST12MONTHSANDWEREABSTINENTATTHETIMEOFSURvEY,BYSEx,2004-2011

FigUrE 5.20: PERCENTAGEOFCURRENTSMOKERSANDRECENTQUITTERS*WHOATTEMPTEDTOQUITINTHEPAST12MONTHSANDWEREABSTINENTATTHETIMEOFSURvEY,BYSEx,2011

% o

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● MALE ● FEMALE

ii: QUittingQUiT sUCCess


Quit Success by AgeIn 2011, smoking abstinence rates among those who attempted toquitinthepast12monthsappeared to decrease with age, but the difference between age groups was not statistically significant56(Figure 5.22). Abstinence rates at the time ofsurveywerearound10%forthose over 25, and slightly higher among younger age groups.

Overtime,quitsuccesswithineach age group has been highly variable, and no clear patterns inquitsuccessbyagehaveemerged (Figure 5.23). The large increase between 2010 and 2011 for those aged 15-19 may be an anomaly.

*INCLUDESCURRENTSMOKERSANDFORMERSMOKERSWHOHADQUITINTHEPAST12MONTHS data SoUrCE: CTUMS, 2011

*INCLUDESCURRENTSMOKERSANDFORMERSMOKERSWHOHADQUITINTHEPAST12MONTHS data SoUrCE: CTUMS, 2004-2011

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FigUrE 5.23: PERCENTAGEOFCURRENTSMOKERSANDRECENTQUITTERS*WHOATTEMPTEDTOQUITINTHEPAST12MONTHSANDWEREABSTINENTATTHETIMEOFSURvEY,BYAGEGROUP,2004-2011

FigUrE 5.22: PERCENTAGEOFCURRENTSMOKERSANDRECENTQUITTERS*WHOATTEMPTEDTOQUITINTHEPAST12MONTHSANDWEREABSTINENTATTHETIMEOFSURvEY,BYAGEGROUP,2011

% o

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ii: QUittingUse oF

CessaTion assisTanCe


6. USE oF CESSation aSSiStanCE6.1 CESSation mEthodSThemajorityofsmokers(57.0%)whoattemptedtoquitusedsomeformofassistance**.The most commonly used form of cessation assistance was nicotine replacement therapy (NRT), used bymorethanathirdofsmokerswhoattemptedtoquit(Figure6.1).Nearlyonequartermadeadealwithafriendorfamilymembertoquit.Reducingcigaretteconsumptionasawaytoquitappearstohaveincreasedinpopularity(Figure6.2),toaroundtwo-thirdsofthosewhoattemptedtoquitin2011.Since 2003, the percentage of smokers who used stop-smoking medications (SSMs) or made a deal with friends or family remained fairly stable. In all years with available data, few smokers reported usingatelephonequitlineorworkplacecessationprogram.


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FigUrE 6.2: PREvALENCEOFUSEOFvARIOUSQUITMETHODSAMONGCURRENTANDFORMERSMOKERSWHOHADQUITORATTEMPTEDTOQUITSMOKINGINTHEPAST2YEARS,2003-2011

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REDUCE # OF CIGARETTES**

NRT

DEAL WITH FRIENDS/FAMILY

MEDICATION LIKE ZYBAN

QUITLINE

WORKPLACE CESSATION PROGRAM

FigUrE 6.1: PREVALENCE OFUSEOFvARIOUSQUITMETHODS*AMONGCURRENTAND FORMER SMOKERS WHO HADQUITORATTEMPTED TOQUITSMOKINGINTHEPAST 2 YEARS, 2011

*NOTE: TOTALS DO NOT ADD TO 100; RESPONDENTS COULD INDICATE MORE THAN ONE METHOD **REDUCINGNUMBEROFCIGARETTESWASNOT INCLUDED AS A FORM OF ASSISTANCEdata SoUrCE: CTUMS, 2011

QU

iT m

eT

ho

d

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● QUiT smoking ConTesT● inTerneT weBsiTe● 1-800 QUITLINE

● 1-800 QUITLINE

● workPlaCe CessaTion Program

● deal wiTh Friends/ Family

● ssm (nrT, ZyBan)

● redUCe # oF CigareTTes

ii: QUittingUse oF CessaTion assisTanCe


6.2 USE oF PharmaCothEraPYNearlyhalf(45.6%)ofthosewhoattemptedtoquithadusedsomekindofstop-smokingmedication(SSM), mostly NRT. Since 2003, use of the nicotine patch, the most popular SSM, decreased somewhat(from33%to25%),whileuseofnicotinegumfluctuatedaroundoneinfive(Figure6.3).Zyban use halved between 2003 and 2008, before increasing in recent years back to 2003 levels.

Use of pharmacotherapy by provinceSeveralprovinces(forexample,Quebec)subsidizedthecostofsomestop-smokingmedications. AsshowninTable6.1,thepercentagesofcurrentsmokersandrecentquitterswhohadusedthenicotinepatch,nicotinegum,or“productlikeZyban”inthepast2yearsvariedbyprovince.


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FigUrE 6.3: PREvALENCEOFUSEOFSTOP-SMOKINGMEDICATIONSAMONGCURRENTANDFORMERSMOKERSWHOHADQUITORATTEMPTEDTOQUITSMOKINGINTHEPAST2YEARS,2003-2011

tablE 6.1: PREvALENCEOFUSEOFSTOP-SMOKINGMEDICATIONSAMONGCURRENTANDFORMERSMOKERSWHOHADQUITORATTEMPTEDTOQUITSMOKINGINTHEPAST2YEARS,BYPROvINCE,2011

ProvinCE niCotinE PatCh niCotinE gUm ProdUCt likE ZYban

Canada 25.5% 19.9% 19.4%

BRITISH COLUMBIA 22.3 23.4 28.9

ALBERTA 22.3 28.5 27.1

SASKATCHEWAN 20.0 26.0 24.6

MANITOBA 18.8 22.6 14.6

ONTARIO 22.1 17.2 19.0

QUEBEC 34.2 17.0 !

NEW BRUNSWICK 25.3 14.8 21.9

NOVA SCOTIA 30.3 23.7 27.5

PRINCE EDWARD ISLAND 31.8 20.3 16.1

NFLD. & LABRADOR 18.0 14.6 !

% o

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nT/

F

or

me

r s

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ke

rs

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● NICOTINE PATCH ● NICOTINEGUM● PRODUCT LIKE ZYBAN

! DATA NOT REPORTABLE DUE TO LOW NUMBERS IN THE NUMERATOR AND/OR DENOMINATOR data SoUrCE: CTUMS, 201

ii: QUittingUse oF

CessaTion assisTanCe


6.3 CESSation adviCE and aSSiStanCE From hEalth ProFESSionalSAmong current smokers surveyed in 2011,overthree-quartershadvisiteda doctor in the past 12 months, while six in ten had seen a dentist (or dental hygienist), and half had talked withapharmacist(Figure6.4).

Of those who had visited health professionals, smokers visiting doctors received advice most often (Figure6.5).Ofsmokerswhohadvisitedadoctorinthepastyear,62%receivedadvicetoquitsmoking,comparedto40%ofthosewhovisitedadentist,and16%ofthosewho had talked to a pharmacist. Since 2003, these rates appear to have increased slowly for doctors and dentists, and remained fairly stable for pharmacists.


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FigUrE 6.5: PERCENTAGEOFvISITORSTOHEALTHPROFESSIONALSWHORECEIvEDADvICETOQUITINTHE PAST 12 MONTHS, 2003-2011

FigUrE 6.4: PERCENTAGEOFCURRENTSMOKERSWHORECEIvEDADvICETOQUITANDINFORMATIONONQUITTINGASSISTANCEFROM HEALTH PROFESSIONALS IN THE PAST 12 MONTHS, 2011


■ ■ ■ %OFSMOKERSvISITED ■ ■ ■ %OFSMOKERSRECEIvEDADvICETOQUIT

■ ■ ■ %OFSMOKERSRECEIvEDINFORMATIONABOUTASSISTANCE

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alT

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DOCTOR PHARMACIST

ii: QUittingUse oF CessaTion assisTanCe


However,ofthosewhovisitedandreceivedadvicetoquit,morereceivedinformationaboutquittingassistancefrompharmacists(70%),comparedtodoctors(63%)ordentists/hygienists(33%)(Figure6.6).

Cessation advice and assistance from health professionals by provinceThepercentagesofcurrentsmokerswhohadreceivedadvicetoquitfromhealthprofessionalsinthepast12monthsvariedbyprovince(Table6.2).


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FigUrE 6.6: PERCENTAGEOFTHOSEWHORECEIvEDADvICEWHOALSORECEIvEDINFORMATIONABOUTQUITTINGASSISTANCEINTHEPAST12MONTHS,2003-2011

! DATA NOT REPORTABLE DUE TO LOW NUMBERS IN THE NUMERATOR AND/OR DENOMINATORdata SoUrCE: CTUMS, 2011

tablE 6.2: PERCENTAGEOFCURRENTSMOKERSWHORECEIvEDADvICETOQUITFROMHEALTHPROFESSIONALS IN THE PAST 12 MONTHS, 2011

ProvinCE doCtor dEntiSt/hYgiEniSt PharmaCiSt

Canada 47.7% (77.2% visited x 61.8% advised)

24.8% (62.0% visited x 40.1% advised)

8.4% (51.1% talked with x 16.5% advised)

BRITISH COLUMBIA 49.2%(79.1x62.7) 25.1% (54.7 x 45.9) !(44.1%talkedwith)

ALBERTA 42.1%(76.8x54.8) 27.7% (58.5 x 47.7) !(56.4%talkedwith)

SASKATCHEWAN 38.1%(76.8x49.7) 19.1% (57.9x 33.3) 12.0% (50.0 x 23.9)

MANITOBA 44.0%(78.4x56.1) 18.7%(60.9x30.9) !(41.1%talkedwith)

ONTARIO 53.9%(80.1x67.3) 29.8%(67.3x44.5) !(53.0%talkedwith)

QUEBEC 43.9%(71.5x61.5) 21.0%(62.3x33.6) !(50.3%talkedwith)

NEW BRUNSWICK 44.9%(75.6x59.4) 12.5% (53.9 x 23.1) 9.9% (50.6x19.6)

NOVA SCOTIA 40.8% (83.8 x 48.7) 13.8%(53.1x26.1) 8.7% (54.0x16.1)

PRINCE EDWARD ISLAND 38.8% (79.4 x 48.9) 17.7%(64.7x27.5) 7.8% (54.3 x 14.4))

NFLD. & LABRADOR 47.3%(85.6x55.3) 17.9% (53.0 x 33.8) 9.0% (51.1 x 17.7)

● DOCTOR ● DENTIST/HYGIENIST● PHARMACIST

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highlighTsAmong youth in grades 6-9, in 2010-11:

15.5% of students in grades 6-9 overall had ever tried a cigarette, ranging from 6% in grade 6 to 27% in grade 9. (page 71)

Nearlyonethirdofnever-smokersingrades6-9were classified as susceptible to smoking. (p. 73)

2.2% of students in grades 6-9 were current smokers overall, with grade-specific rates ranging from too low to report in grade 6 and 0.7% for grade 7, to 4.9% for grade 9 students. (p. 75)

•Smokerswerefairlyevenlysplitbetweendaily(0.9%)andnon-daily(1.2%)smoking.(p. 75)

•Similarpercentagesofmales(2.2%)andfemales(2.1%)werecurrentsmokers. (p.77)

•Prevalencevariedbyprovince,andwashighestinQuebecandSaskatchewan,at4.3%.(p. 78)

Daily smokers in grades 7-9 smoked an average of 8.7 cigarettes per day. (p. 80)

7.5% of students in grades 6-9 had ever smoked a cigar or cigarillo. (p. 84)

Mostsmokersingrades6-9usuallyobtainedtheircigarettes from social sources, including buying, taking, or being given cigarettes by friends, family or others, or having others buy for them. (p. 82)

Sevenoutoftencurrentsmokersingrades6-9reportedevertryingtoquitsmoking. (p. 88)

Among youth aged 15-19, in 2011:Oneinfour(24.3%)youthreportedeverhavingsmokedawholecigarette,rangingfrom12%of15-year-oldsto40%of19-year-olds.(page 73)

11.8% of youth aged 15-19 were current smokers overall, with age-specific rates ranging from 5.1% for 15-year-olds to 21.0% for 19-year-olds. (p. 75)

•Similarpercentagesofyouthsmokeddaily(6.0%)andnon-daily(5.8%).(p. 75)

•Prevalencewas13.0%amongmalesand10.5%amongfemales.(p.77)

Byprovince,prevalencerangedfromjustover8%inAlbertatonearly20%inSaskatchewan.(p. 79)

17% of youth aged 15-19 had ever smoked a cigar, and 27% had ever smoked a cigarillo. (p. 84)

•Malesweremorelikelytohaveusedtheseproducts:24%ofmales(vs.9%offemales)had smoked a cigar, while one third of males (vs.20%offemales)hadsmoked a cigarillo. (p. 85)

Daily smokers aged 15-19 smoked an average of 11.7 cigarettes per day. (p. 80)

55%ofsmokersaged15-18usuallyobtainedcigarettes from retail sources, while more than a third obtained them through social sources. (p. 82)

56%ofsmokersaged15-19wereseriouslyconsideringquittinginthenext6months. (p. 87)

two-thirds of smokers aged 15-19 had made a quit attempt in the past 12 months. (p. 89)

Section iii: Tobacco Use Among Canadian youth


iii: YoUthsmoking iniTiaTion


7. Smoking initiationPrevious research indicates that most smokers begin smoking by age 19x. Accordingly, preventing smoking initiation is the target of many youth tobacco interventions, and youth initiation is monitored by Canada’s national tobacco surveys.

7.1 EvEr SmokingEver smoking among students in grades 6-9In2010-11,themajority(84.5%)ofstudentsingrades6-9surveyedhadnevertriedsmokingcigarettes,rangingfrom94.0%ingrade6to73.3%ingrade9.However,15.5%ofstudentsoverallhad tried smoking. Figure 7.1 (below) provides a breakdown of the smoking status of these students.

In 2010-11, a higher percentage57ofmalestudents(16.6%)hadtriedsmokingcigarettes,comparedtofemales(14.3%)ingrades6-9.

CUrrEnt SmokEr:SMOKED100+CIGARETTESINLIFETIME,INCLUDING: • Daily smoker-ATLEASTONECIGARETTEPERDAYFOREACHOFTHE30DAYSPRECEDINGTHESURvEY • NoN-Daily smoker-ATLEASTONECIGARETTEDURINGTHELAST30DAYS,BUTNOTEvERYDAYFormEr SmokEr:SMOKED100+CIGARETTESINLIFETIMEANDHASNOTSMOKEDATALLINTHELAST30DAYSbEginnEr/ExPErimEntEr: SMOKED ≥1WHOLECIGARETTEANDHASSMOKEDINTHELAST30DAYSPaSt ExPErimEntEr: SMOKED ≥1WHOLECIGARETTEANDHASNOTSMOKEDATALLINTHELAST30DAYSPUFFEr:TRIEDAFEWPUFFS,BUTNEvERSMOKEDAWHOLECIGARETTEdata SoUrCE: YOUTHSMOKINGSURvEY(YSS),2010-11

FigUrE 7.1: SMOKINGSTATUSOFSTUDENTSINGRADES6-9WHOHADEvERTRIEDSMOKINGCIGARETTES,2010-11

85%ofstudentsingrades6-9hadnever tried smoking cigarettes.

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iii: YoUthsmoking

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data SoUrCE:YSS,1994,2002,2004-05,2006-07,2008-09,2010-11

data SoUrCE: YSS, 2010-11 *IN 2010-11, NEW BRUNSWICK DECLINED PARTICIPATION IN THE YSS.

FigUrE 7.2: PERCENTAGEOFSTUDENTSINGRADES6-9WHOHADEvERTRIEDSMOKINGACIGARETTE, BYGRADE,1994-2010-11

FigUrE 7.3: PERCENTAGEOFSTUDENTSINGRADES6-9WHOHADEvERTRIEDSMOKINGACIGARETTE,BYPROvINCE*,2010-11

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Theoverallpercentageofstudentsingrades6-9whohadevertriedsmokingdroppeddrasticallybetween 1994 and the 2000s, and then remained fairly stable before again dropping significantly between 2008-09 and 2010-1158 (Figure 7.2). The percentage of students who had tried smoking acigaretteincreasedwithgradelevel:in2010-11,6%ofstudentsingrade6hadtriedsmoking,comparedto27%ofgrade9students.

The percentage of students ingrades6-9whohadevertried smoking a cigarette varied significantly by province59 (Figure 7.3). Forexample,just8.7%ofOntario youth had tried smoking, while nearly triple that(24.4%)inQuebec had tried.

Note that there are no provincial estimates for New Brunswick for the 2010-11 YSS, as the province declined participation.

% o

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■ OVERALL ■ GRADE6■ GRADE7■ GRADE8■ GRADE9

iii: YoUthsmoking iniTiaTion


Ever smoking among youth aged 15-19Amongyouthaged15-19,24.3%reportedeverhavingsmokedawholecigarettein2011.Thiswasnotsignificantly different from the 2010 rate60, although this proportion has halved since 1999 (Figure 7.4).Significantlymoremales(28.3%)thanfemales(20.0%)hadeversmokedawholecigarette61.

The percentage of students who had ever smoked a whole cigarette increased with age in most years between 1999 and 2010. This age gradient appeared to be particularly steep in the most recent years, when 19-year-olds had triple the rate of ever smoking a whole cigarette compared to 15-year-olds.

It appears that in addition to fewer youth starting to smoke over time, fewer youth are initiating smoking in their early teens. Rather, youth are continuing to pick up the habit throughout adolescence; in the past few years, more youth smoked their first cigarette after age 15 than earlier. In2011,themeanageatwhichever-smokersage25andoversmokedtheirfirstcigarettewas16.1.


*StudentswereclassifiedasNOTsusceptibleiftheyresponded“definitelynot”tothefollowingthreeitems: “Do you think in the future you might try smoking cigarettes?”, “If one of your best friends was to offer you a cigarette would you smoke it?”, and “At any time during the next year do you think you will smoke a cigarette?”; all other students were classified as susceptible.

FigUrE 7.4: PERCENTAGEOFYOUTHAGED15-19WHOHADEvERSMOKEDAWHOLECIGARETTE,BYAGE,1999-2011

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7.2 SUSCEPtibilitY to SmokingAlthough current smoking rates were fairly low among the youngest respondents, students may be susceptibletofuturesmoking.Susceptibilitytosmokingisdefinedas“theabsenceofafirmdecisionnot to smoke,” and can predict future smoking among youthxi.

Overall,31.8%ofnever-smokersingrades6-9wereclassifiedassusceptibletosmoking*in2010-11,unchanged from 2008-0962.Asignificantlygreaterpercentageofmales(32.9%)weresusceptibletosmoking,comparedtofemales(30.7%)63.

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■ OVERALL ■ 15 ■ 16■ 17 ■ 18 ■ 19

iii: YoUthsmoking

iniTiaTion


*FROM2004-05TO2010-11,SUSCEPTIBILITYWASDEFINEDASOUTLINEDABOvE(PAGE73).IN1994AND2002,STUDENTSWERECLASSIFIEDASNOTSUSCEPTIBLEIFTHEYRESPONDED“NO”TOBOTHOFTHEFOLLOWINGITEMS:“HAvE YOU EvER SERIOUSlY THOUgHT ABOUT TRYIng SmOkIng?” AND “DO YOU THInk YOU mIgHT TRY SmOkIng wITHIn THE nExT mOnTH?”; OTHERS WERE CLASSIFIED AS SUSCEPTIBLE.

data SoUrCE:YSS,1994,2002,2004-05,2006-07,2008-09,2010-11

data SoUrCE: YSS, 2010-11 *IN 2010-11, NEW BRUNSWICK DECLINED PARTICIPATION IN THE YSS.

FigUrE 7.5: PERCENTAGEOFNEvER-SMOKERSINGRADES6-9WHOWERESUSCEPTIBLETOSMOKING*,BYGRADE,1994-2010-11

FigUrE 7.6: PERCENTAGEOFNEvER-SMOKERSINGRADES6-9WHOWERESUSCEPTIBLETOSMOKING,BYPROvINCE*,2010-11

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Susceptibility to smoking by gradeSusceptibilitytosmokingamongnever-smokingstudentsingrades6-9didnotchangesignificantlybetween 2008-09 and 2010-1161 (Note: comparisons with earlier survey years are not possible due to questionchanges)(Figure7.5).Thepercentageofnever-smokerswhoweresusceptibletosmokingincreasedwithgradeleveluptograde8:forexample,in2010-11,28%ofstudentsingrade6weresusceptible,while35%ofgrade8studentsweresusceptible.Susceptibilityamonggrade9studentswas the same or lower than among grade 8 students in all years.

Susceptibility to smoking by provinceThe percentage of students ingrades6-9whoweresusceptible to smoking varied significantly by province64(Figure7.6).Forexample,just26%ofstudents in Prince Edward Island were susceptible tosmoking,while35%ofstudents in Nova Scotia were susceptible.

■ OVERALL ■ GRADE6■ GRADE7■ GRADE8■ GRADE9

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iii: YoUthCUrrenT smoking


8. CUrrEnt Smoking among YoUth8.1 Smoking PrEvalEnCE

In 2010-11, the smoking rate among students in grades6-9was2.2%overall,althoughitvariedsubstantially by grade from too low to report to 5%(Figure8.1).Amongadolescentsaged15-19,12%werecurrentsmokersin2011,againwithsubstantialvariationbyage,from5to21%.Dailysmoking accounted for about half of smoking among youth, increasing with age.

Smoking prevalence among students in grades 6-9remainedfairlysteadythroughoutthe2000’s, at less than half of the 1994 rate, but decreased significantly between 2008-09 and 2010-11, overall65and for both daily and non-daily smoking66,67 (Figure 8.2). Among youth aged 15-19, smoking prevalence declined steadily from 1999 to 2003, where it remained ataround18%until2005,beforedroppingtoaround15%forthenextfewyearsandthenbeginning to decline again around 2009 (Figure 8.2). Between 2010 and 2011, there was no significant change in overall prevalence68, daily smoking69 or non-daily smoking70. Most of the decline in smoking observed among 15- to 19-year-olds appears to be due to decreasing daily smoking rates; non-daily smoking prevalence has fluctuated around 6-8%throughouttheyearsstudied.

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FigUrE 8.2: CURRENTSMOKINGPREvALENCE*(DAILYANDNON-DAILY),GRADES6-9ANDAGE15-19,1994-2011

* CURRENT DAILY/NON-DAILY SMOKER AND SMOKED IN PAST 30 DAYS data SoUrCES:CTUMS,1999-2011;YSS,1994,2002,2004-05,2006-07,2008-09,2010-11

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FigUrE 8.1: CURRENTSMOKINGPREvALENCE,GRADES6-9,2010-11,ANDAGE15-19,2011

data SoUrCES: CTUMS, 2011; YSS, 2010-11

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nTs

grade/age groUP




Smoking Prevalence by AgeSmoking prevalence appeared to increase with age: smoking rates were too low to report amonggrade6students,butincreasedfairlysteadilyto21%of19-year-olds(Figure8.3).

As noted, data up to grade 9 are provided by the YSS, and data from CTUMS are used for older youth (see p.96). Any difference observed between grade 9 students and 15-year-olds could be due to differences in survey methodologies.

Among students in grades 7-9, smoking patterns by grade were fairly stable between 2002 and 2010-11, and much lower in these years than in 1994 (Figure 8.4). Over time, smoking among youth aged 15-17 has declined fairly steadily, while smoking among 18- to 19-year-olds has also declined, albeit with less consistency (slight increases in some years) and has plateaued in recent years (Figure 8.4). This has led to a greater difference in smoking rates between older and younger adolescents: in 2011, the smoking rate among 18- to 19-year-olds was more than double that of 15- to 17-year olds.

0

5

10

15

20

25

GR. 7* GR. 8 GR. 9 15 16 17 18 19

0

5

10

15

20

25

30

35

1994 - 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

FigUrE 8.3: CURRENTSMOKINGPREvALENCEBYGRADE/AGE,GRADES7-9*,2010-11,ANDAGE15-19,2011

FigUrE 8.4: CURRENTSMOKINGPREvALENCE*BYGRADE/AGE,GRADES7-9**ANDAGE15-19,1994-2011

*DATAFORGR.6,ANDGR.7‘DAILY’NOTREPORTABLEDUETOLOWNUMBERS IN THE NUMERATOR AND/OR DENOMINATOR data SoUrCES: CTUMS, 2011; YSS, 2010-11

*FORGRADES7-9:CURRENTDAILY/NON-DAILYSMOKERANDSMOKEDINPAST30DAYS;FORAGE15-19:CURRENTDAILYORNON-DAILYSMOKER**DATAFORGRADE6NOTREPORTABLEDUETOLOWNUMBERSINTHENUMERATORAND/ORDENOMINATOR data SoUrCES:CTUMS,1999-2011;YSS,1994,2002,2004-05,2006-07,2008-09,2010-11

% o

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esP

on

de

nTs

% o

F r

esP

on

de

nTs

grade/age groUP

sUrVey year


■ GRADE7■ GRADE8■ GRADE9■ AGE15-17 ■ AGE18-19



Smoking Prevalence by SexSmoking prevalence was not significantly different between males and females amongstudentsingrades6-9in2010-1171 or among youth aged 15-19 in 201172 (Figure 8.5).

Over time, among 15- to 19-year-olds, prevalence patterns have shifted from higher female smoking prevalence up until 2005, to greater percentages of males smoking in the most recent years, although this difference was not significant in 201172 (Figure8.6).

Amongstudentsingrades6-9,thesamegeneral pattern was observed, although with much smaller differences between the sexes: females had slightly higher smoking rates from 1994 to 2004-05, and males had slightly higher rates in more recent years, althoughthisappearstohaveequalizedin2010-11(Figure8.6).

0

2

4

6

8

10

12

14

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9

199

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200

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-11

2010

-11

2010

2010

2011

2011

0

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20

25

30

FigUrE 8.5: CURRENTSMOKINGPREvALENCEBYSEx,GRADES6-9,2010-11,ANDAGE15-19,2011

FigUrE 8.6: CURRENTSMOKINGPREvALENCE(DAILYANDNON-DAILY)BYSEx,GRADES6-9AND AGE15-19,1994-2011

data SoUrCES: CTUMS, 2011; YSS, 2010-11

data SoUrCES:CTUMS,1999-2011;YSS,1994,2002,2004-05,2006-07,2008-09,2010-11

% o

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de

nTs

% o

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on

de

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MALESGR.6-9

MALESAGE15-19

FEMALESAGE15-19

FEMALESGR.6-9

MALESGR.6-9 MALESAGE15-19 FEMALESAGE15-19FEMALESGR.6-9

■ ■ NON-DAILY ■ ■ DAILY



Smoking Prevalence by Province

PreValenCe among STUDENTS IN gRADES 6-9

Smoking prevalence among studentsingrades6-9varied significantly by province in 2010-1173

(Figure 8.7). Prevalence washighestinQuebecandSaskatchewan,at4.3%.

Between 1994 and 2004-05, smoking declined substantially in all provinces (Table 8.1). From 2008-09 to 2010-11, prevalence appears to have decreased slightly in most provinces.

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

PQ SK NF NS CA BC MB ON AB PEI

FigUrE 8.7: CURRENTSMOKINGPREvALENCE*BYPROvINCE**,GRADES6-9,2010-11

tablE 8.1: CURRENTSMOKINGPREvALENCE*BYPROvINCE,GRADES6-9,1994-2011

*INCLUDES DAILY AND NON-DAILY SMOKERS** IN 2010-11, NEW BRUNSWICK DECLINED PARTICIPATION IN THE YSS.! DATA NOT REPORTABLE DUE TO LOW NUMBERS IN THE NUMERATOR AND/OR DENOMINATORdata SoUrCE: YSS, 2010-11

* CURRENT DAILY/NON-DAILY SMOKER AND SMOKED IN PAST 30 DAYS** IN 2010-11, NEW BRUNSWICK DECLINED PARTICIPATION IN THE YSS.! DATA NOT REPORTABLE DUE TO LOW NUMBERS IN THE NUMERATOR AND/OR DENOMINATORdata SoUrCE:YSS,1994,2002,2004-05,2006-07,2008-09,2010-11

YEar 1994 2002 2004-05 2006-07 2008-09 2010-11

Canada 7.9 3.3 2.1 3.0 3.5 2.2

BRITISH COLUMBIA 7.7 2.3 ! 3.0 3.2 2.0

ALBERTA 7.5 ! ! ! ! !

SASKATCHEWAN 6.1 3.2 2.1 ! 6.1 4.3

MANITOBA 6.8 4.2 2.1 3.2 2.5 1.7

ONTARIO 4.6 ! 1.0 1.9 1.4 1.0

QUEBEC 14.1 7.6 4.3 5.2 7.6 4.3

NEW BRUNSWICK 8.0 5.1 3.3 3.3 3.8 **

NOVA SCOTIA 7.6 4.6 2.9 3.8 2.8 3.3

PRINCE EDWARD ISLAND 7.7 ! ! 2.3 2.2 !

NFLD. & LABRADOR 9.3 5.9 3.8 ! 5.6 4.0

% o

F r

esP

on

de

nTs

ProVinCe

NOTREPORTABLE



PreValenCe among YOUTh AgED 15-19

Among youth aged 15-19, smoking prevalence varied significantly by province74 in 2011 (Figure 8.8). Prevalence rangedfromjustover8%inAlbertatonearly20%inSaskatchewan.

Between 1999 and 2011, smoking prevalence decreased substantially in all provinces; during this time, smoking rates were reduced by more than half in Canada, as well as in most provinces (Table 8.2).

0

5

10

15

20

25

SK PQ PEI MB NB NS CA NF BC ON AB

FigUrE 8.8: CURRENTSMOKINGPREvALENCE*BYPROvINCE,AGE15-19,2011

tablE 8.2: CURRENTSMOKINGPREvALENCE*BYPROvINCE,AGE15-19,1999-2011

*INCLUDES DAILY AND NON-DAILY SMOKERSdata SoUrCE: CTUMS, 2011

*INCLUDES DAILY AND NON-DAILY SMOKERSdata SoUrCE: CTUMS, 1999-2011

YEar 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Canada 27.7 25.3 22.5 22.0 18.3 18.4 18.1 14.9 15.2 14.8 13.0 12.2 11.8


ALBERTA 26.4 24.4 24.1 19.0 18.1 15.7 18.9 15.2 20.1 16.0 12.4 17.0 8.3

SASKATCHEWAN 31.4 24.1 27.1 29.0 28.2 24.7 24.9 20.8 22.0 20.0 18.3 20.3 19.8

MANITOBA 29.5 25.4 28.2 23.3 20.3 21.0 20.0 19.7 20.1 17.0 17.9 15.0 14.3

ONTARIO 24.8 25.1 18.8 19.2 14.5 16.8 16.0 12.5 13.5 12.8 9.1 9.1 9.1

QUEBEC 35.7 29.6 28.6 32.0 25.5 24.1 22.8 18.3 17.4 16.6 18.1 15.0 17.3

NEW BRUNSWICK 27.4 29.9 24.6 17.6 21.6 17.7 17.9 15.7 16.8 14.2 15.7 11.9 13.8

NOVA SCOTIA 30.1 25.1 26.8 20.2 18.4 20.3 12.9 14.8 13.4 14.4 14.2 15.8 11.8


NFLD. & LABRADOR 29.9 28.4 22.0 22.2 22.0 21.1 19.0 16.2 16.8 14.7 16.0 15.1 11.1

% o

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on

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nTs

ProVinCe



8.2 CigarEttE ConSUmPtionIn 2010-11, average daily cigarette consumption among daily smokers in grades 7-9 was 8.7, which was not significantly different from the 2008-09 rate of 10.975. Among 15- to 19-year-olds, average daily cigarette consumption was 11.7 in 2011, no significant change from 201076.

Cigarette Consumption by SexAmong daily smokers in grades 7-9, mean daily cigarette consumption was similar among males and females in 2010-1177 (Figure 8.9). In this age group, consumption appears to have fluctuated over time among males, but remained stable among females (Figure 8.10).

Among daily smokers aged 15-19, there was no significant difference in daily cigarette consumption between males and females in 201178 (Figure 8.9). However, males appeared to have smoked more than females in all preceding years (Figure 8.10).

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FigUrE 8.9: AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,GRADES7-9,2010-11,ANDAGE15-19,2011

FigUrE 8.10: AvERAGEDAILYCIGARETTECONSUMPTION*BYSEx,GRADES7-9ANDAGE15-19,1994-2011

*AMONGDAILYSMOKERSdata SoUrCES: CTUMS, 2011; YSS 2010-11

*AMONGDAILYSMOKERSdata SoUrCES:CTUMS,1999-2011;YSS,1994,2002,2004-05,2006-07,2008-09,2010-11

me

an

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ar

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Te

s P

er

me

an

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ar

eT

Te

s P

er

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y

sex/age groUP

MALESGR.6-9

MALESGR.6-9

199

4

200

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-11

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199

9

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9

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3

MALESAGE15-19

MALESAGE15-19

FEMALESAGE15-19

FEMALESAGE15-19

FEMALESGR.6-9

FEMALESGR.6-9



Cigarette Consumption by AgeIn 2010-11/2011, cigarette consumption appeared to generally increase with age among daily smokers (Figure 8.11).

Among daily smokers aged 15-19, average daily cigarette consumption has decreased overall between 1999 and 2011, although there has not been much net change in the last 5 years (Figure 8.12). Among smokers in grades 7-9, daily cigarette consumption has remained roughly between 9 and 11 since 1994.

0

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Gr. 7/8** Gr. 9 15/16** 17 18 19

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FigUrE 8.11: AvERAGEDAILYCIGARETTECONSUMPTION*BYAGE,GRADES7-9,2010-11,ANDAGE15-19,2011

FigUrE 8.12: AvERAGEDAILYCIGARETTECONSUMPTION*BYAGEGROUP,GRADES7-9ANDAGE15-19,1994-2011

*AMONGDAILYSMOKERS**GRADE7/8ANDAGE15/16HAvEBEENCOMBINEDDUETOLOWNUMBERSdata SoUrCE: CTUMS, 2011; YSS 2010-11

*AMONGDAILYSMOKERSdata SoUrCE:CTUMS,1999-2011;YSS,1994,2002,2004-05,2006-07,2008-09,2010-11

me

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grade/age

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GRADES7-9 AGE15-17 AGE18-19

iii: YoUthsoUrCes oF CigareTTes


BUY MYSELF AT A STORE, 17.6%

BUY FROM A FRIEND, 14.2%

BUY FROM SOMEONE ELSE,

6.4%

ASK SOMEONE TO BUY THEM FOR ME,

23.4%

GIVEN BY/TAKE FROM SIBLING OR

PARENT, 20.0%

GIVEN BY A FRIEND/SOMEONE

ELSE, 10.0%

OTHER, 8.5%

9. SoUrCES oF CigarEttESSOURCES OF CIgARETTES FOR STUDENTS IN gRADES 6-9 In2010-11,whensmokersingrades6-9wereaskedwheretheyusuallygottheircigarettes,mostreported obtaining them from social sources. Nearly half of smokers usually asked someone to buy cigarettesforthem,orboughtthemfromafriendorsomeoneelse.Another30%reportedbeinggiven cigarettes by a friend, family member or someone else, or taking them from a family member. Approximately one in six smokers reported usually purchasing cigarettes from a store themselves (Figure 9.1).

FigUrE 9.1: USUALSOURCESOFCIGARETTESFORCURRENTSMOKERS*INGRADES6-9,2010-11

*CURRENTSMOKER=SMOKED100+CIGARETTESINLIFETIMEANDSMOKEDINTHEPAST30DAYSdata SoUrCE: YSS, 2010-11

Thevastmajorityofsmokersingrades6-9reportedobtainingtheircigarettes fromsocialsources.Incontrast,themajority(55%)ofsmokersage

15-18 reported obtaining their cigarettes from a retail source.

iii: YoUthsoUrCes oF CigareTTes


BUY FROM SMALL GROCERY/

CONVENIENCE STORE, 45.9%

BUY FROM GAS STATION, 9.2%

GET FREE FROM FAMILY/FRIEND/ SOMEONE ELSE,

36.2%

OTHER, 8.8%

0 10 20 30 40 50 60 70 80 90 100

BEEN ASKED FOR ID

BEEN REFUSED SALE

The legal age to purchase cigarettes is 19 in most provinces, with the exception of Alberta, Saskatchewan, Manitoba,andQuebec,wherethe legal purchase age is 18. In the age group 15-18, most of the smokers surveyed would be underage for purchasing cigarettes.

In 2011, when smokers aged 15-18 were asked where they usuallygottheircigarettes,55%reported purchasing them from a retail source, primarily small grocery/convenience stores and gas stations (Figure 9.2). More than a third reported being given cigarettes by another person, including friends, family and others. Nine percent reported getting cigarettes from“Other”sources.

SOURCES OF CIgARETTES FOR 15- TO 18-YEAR-OLDS

FigUrE 9.2: PERCENTAGEOFSMOKERSAGED15-18WHOUSUALLYGOTCIGARETTESFROMvARIOUSSOURCES,2011

FigUrE 9.3: PERCENTAGEOFSMOKERSAGED15-18WHOWEREASKEDFORIDORREFUSEDSALEOFCIGARETTES,AMONGTHOSEWHOUSUALLYBUYCIGARETTESFROMASTOREORBOUGHTTHEMINTHE PAST 12 MONTHS, 2011

*SOMECATEGORIESHAvEBEENCOMBINEDDUETOLOWNUMBERS:“BUYFROMSMALLGROCERY/CONvENIENCESTORE”INCLUDES“SUPERMARKET”AND“ANOTHERKINDOFSTORE”;“OTHER”INCLUDES“BUYFROMAFIRSTNATIONSRESERvE”AND“OTHER”.data SoUrCE: CTUMS, 2011


In2011,morethanhalf(57.7%)of all current smokers aged 15-18 had asked someone to buy cigarettes for them in the past 12 months.

Among 15- to 18-year-olds who had bought cigarettes from a store in the past 12 months, three-quarters(75.8%)hadeither been asked for ID or been refused sale (Figure 9.3).

% oF smokers

iii: YoUthoTher

ToBaCCo ProdUCTs


10. USE oF othEr tobaCCo ProdUCtSIn2010-11,6%ofstudentsingrades6-9reportedhavingeversmokedacigarillo,andnearly5%hadsmokedacigar(Figure10.1).In2011,amongyouthaged15-19,thesefigureswere27%and17%,respectively. Far fewer youth reported having smoked a pipe, or used smokeless tobacco.

Among youth aged 15-19, ever use of cigars/cigarillos increased between 2003-2007 but has declined in recent years, while ever use of a pipe or chewing tobacco/pinch/snuff has remained fairly stable over this time (Figure 10.2). Between 2010 and 2011, there was no significant change in use of either cigars/cigarillos79, pipe80 or chewing tobacco/pinch/snuff81 in the 15-19 age group. Among students ingrades6-9,everuseofothertobaccoproductsdecreasedbetween1994and2004-05andhasremained low, but varied, since then. Between 2008-09 and 2010-11, use of cigars/cigarillos82 and pipe83 decreased significantly, but there was no significant change in use of smokeless tobacco84.

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FigUrE 10.1: PERCENTAGEOF YOUTH WHO HAD EVER TRIED VARIOUS TOBACCO PRODUCTS, GRADES6-9,2010-11, ANDAGE15-19,2011

FigUrE 10.2: PERCENTAGEOFYOUTHINGRADES6-9ANDAGE15-19WHOHADEvERTRIEDvARIOUSTOBACCO PRODUCTS, 1994-2011

data SoUrCE: CTUMS, 2011; YSS, 2010-11

notE:CATEGORIESHAvEBEENCOMBINEDINSOMECASES:CTUMSITEMSFORCIGARSANDCIGARILLOSCOMBINEDIN2007-2011;YSSITEMSFORCIGARSANDCIGARILLOSCOMBINEDIN2008-09;YSSASKEDABOUTCIGARS,CIGARILLOS,ANDPIPEASASINGLEITEMPRIORTO2006-07;YSSITEMSFORCHEWINGTOBACCOANDSNUFFCOMBINEDFOR1994-2006-07,ANDASKEDASASINGLEITEMABOUT“SMOKELESSTOBACCO”IN2008-09AND2010-11data SoUrCE: CTUMS,2003-2011;YSS,1994,2002,2004-05,2006-07,2008-09,2010-11

% o

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% o

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GRADES6-9

GRADES6-9

CIGARS/ CIGARILLOS

(+ PIPE FOR 1994-2004-05)

PIPE PIPESMOKELESS TOBACCO

CHEWING TOBACCO/PINCH/

SNUFF

CIGARS/ CIGARILLOS

199

4

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320

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52006

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AGES15-19

CIGARILLO

S

CIGARILLO

S

CIGARS

CIGARS

PIP

E PIP

E

SM

OK

ELE

SS

TO

BA

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O

CHEWINGTOBACCO/

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/SN

UF

F

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IPE W

AT

ER

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E

iii: YoUthoTher ToBaCCo ProdUCTs


FlaVoUred ToBaCCo ProdUCTs

Previous research has shown that flavoured tobacco products have greater appeal among youthxii, and recent federal legislation (Cracking Down on Tobacco marketing Aimed at Youth Actxiii) was enacted in an effort to limit youth access to such products. However, flavoured products remain popular among youth.

Amongallstudentsingrades6-9,7.8%reportedever using flavoured tobacco products.

Figure 10.3 shows the percentage of youth who had used a flavoured product in the last 30 days, among those who had used each type of productinthelast30days.Overall,70%ofyouthingrades6-9and80%ofyouthaged15-19whohad used any non-cigarette tobacco products in the last 30 days had used a flavoured product, although this varied by product.

demograPhiC PaTTerns in oTher ToBaCCo UseUse of Other Tobacco Products by SexIn 2011, among youth aged 15-19, significantly more males than females had tried all tobacco products85-88 (Figure 10.3). This gender difference appeared to be particularly large for cigars, pipe and chewing tobacco/snuff. A similar pattern was observed among younger students, with more malesthanfemalesingrades6-9evertryingmostothertobaccoproducts89-91, except waterpipe92.

0

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FigUrE 10.4: PERCENTAGEOFYOUTHWHOHADEvERTRIEDvARIOUSTOBACCOPRODUCTS,BYSEx,GRADES6-9,2010-11,ANDAGE15-19,2011


% o

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CIGARILLOS CIGARILLOSCIGARS CIGARSPIPE PIPESMOKELESS CHEWINGTO-BACCO/

PINCH/SNUFF

WATERPIPE WATERPIPE

0

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FigUrE 10.3: PERCENTAGEOFYOUTHWHOHAD USEDFLAvOUREDTOBACCOPRODUCTS,AMONGLAST30-DAYUSERS,GRADES6-9,2010-11,AND AGE15-19,2011ANDAGE15-19,2011


% o

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de

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GRADES6-9 AGES15-19

Cig

ar

illo

S

Cig

ar

illo

S

Cig

ar

S

Cig

ar

S

Smo

kE

lESS

to

ba

CC

o

Ch

Ew

ing

to

ba

CC

o/

Pin

Ch

/Sn

UFF

wa

tEr

PiP

E

wa

tEr

PiP

E■ MALE ■ FEMALE

iii: YoUthoTher

ToBaCCo ProdUCTs


Use of Other Tobacco Products by ProvinceUseofothertobaccoproductsamongstudentsingrades6-9variedsignificantlybyprovinceforalltobacco products93-96(Table10.1).Quebechadthehighestpercentageofyouthevertryingcigars(9%),cigarillos(12%),andwaterpipe(4%).

Similarly, among youth aged 15-19, use of other tobacco products varied by province, significantly for cigars/cigarillos, chewing tobacco/snuff, and waterpipe97-100(Table10.2).Quebechadthehighestpercentageofyouthevertryingcigarillos,andQuebecandSaskatchewanhadthehighestpercentagestrying cigars. Saskatchewan also had the highest percentage of youth who had used chewing tobacco orsnuff.QuebecandAlbertahadthehighestpercentagesofyouthtryingawaterpipe.

tablE 10.1: PERCENTAGEOFYOUTHINGRADES6-9WHOHADEvERTRIEDvARIOUSTOBACCOPRODUCTS,BY PROVINCE, 2010-11

tablE 10.2: PERCENTAGEOFYOUTHAGED15-19WHOHADEvERTRIEDvARIOUSTOBACCOPRODUCTS,BYPROVINCE, 2011

! DATA NOT REPORTABLE DUE TO LOW NUMBERS IN THE NUMERATOR AND/OR DENOMINATOR data SoUrCE: CTUMS, 2011

ProvinCE Cigarillos Cigars Pipe Smokeless tobacco waterpipe

Canada 6.0% 4.5% 2.3% 1.4% 2.3%BRITISH COLUMBIA 5.9 3.9 2.9 1.9 2.1

ALBERTA 6.6 5.6 3.3 2.4 !

SASKATCHEWAN 6.6 5.6 3.1 3.3 !

MANITOBA 5.4 3.0 2.5 1.2 1.2

ONTARIO 2.1 1.7 1.2 1.0 1.3

QUEBEC 11.9 8.9 2.9 ! 4.1

NEW BRUNSWICK * * * * *

NOVA SCOTIA 8.1 5.2 3.7 2.4 2.0

PRINCE EDWARD ISLAND 2.5 2.1 ! ! !

NFLD. & LABRADOR 8.0 5.8 2.8 ! 1.6

ProvinCE Cigarillos Cigars Pipe Chewing tobacco/snuff waterpipe

Canada 26.9% 16.9% 5.3% 5.2% 12.3%BRITISH COLUMBIA 23.6 15.1 ! ! 9.3

ALBERTA 26.1 15.9 ! 7.2 15.2

SASKATCHEWAN 32.4 20.8 8.3 17.4 9.1

MANITOBA 27.2 15.7 6.4 7.3 5.9

ONTARIO 22.0 15.3 ! ! 11.2

QUEBEC 37.5 20.9 ! ! 17.9

NEW BRUNSWICK 29.7 18.9 6.6 6.8 5.2

NOVA SCOTIA 24.8 17.1 7.6 7.8 7.4

PRINCE EDWARD ISLAND 20.4 15.9 9.4 11.9 8.9

NFLD. & LABRADOR 23.7 12.4 ! ! !

! DATA NOT REPORTABLE DUE TO LOW NUMBERS IN THE NUMERATOR AND/OR DENOMINATOR *IN 2010-11, NEW BRUNSWICK DECLINED PARTICIPATION IN THE YSS.data SoUrCE: YSS, 2010-11

iii: YoUthQUiTTing smoking


0

10

20

30

40

50

60

70

80

90

100

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

11. QUitting Smoking11.1 QUit intEntionSIn2011,56.0%ofsmokersaged15to19wereseriouslyconsideringquittinginthenext6months,andhalf(47.9%)ofthosewereconsideringdoingsointhenext30days(Figure11.1).Since2000,thepercentageofsmokersseriouslyconsideringquittinghasfluctuatedbetween60to70%(Figure11.1).

FigUrE 11.1: PERCENTAGEOFSMOKERSAGED15-19SERIOUSLYCONSIDERINGQUITTINGINTHENExT 6MONTHS,ANDINTHENExT30DAYS,2000-2011


the majority of youth smokers were interested in quitting:

•56%ofsmokersaged15to19wereseriouslyconsideringquitting

•Sevenoutoftensmokersingrades6-9,andtwo-thirdsofsmokersaged15-19hadeverattemptedtoquit

•56%ofsmokersaged15-19hadattemptedtoquitinthepastyear

● INTHENExT6MONTHS● INTHENExT30DAYS

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11.2 QUit attEmPtSQuit attempts among students in grades 6-9Amongcurrentsmokersingrades6-9,sevenoutoften(70.2%)hadevertriedtoquitsmoking.

Mostsmokerswhohadevertriedtoquithadmadeonetothreeattempts,with15%havingmade 4 or more attempts (Figure 11.2).

Between 2008-09 and 2010-11, there was no significant difference in the percentage of smokersingrades6-9whohadevertriedtoquitsmoking101.

The percentage of current smokers who had everattemptedtoquithasremainedfairlystableover time at around two-thirds, although there is some variation from wave to wave (Figure 11.3).

FigUrE 11.3: PERCENTAGEOFCURRENTSMOKERSWHOHADEVERMADEAQUITATTEMPT,GRADES6-9,1994-2010-11

data SoUrCE:YSS,1994,2002,2004-05,2006-07,2008-09,2010-11

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FigUrE 11.2: NUMBEROFQUITATTEMPTSEVER MADEBYCURRENTSMOKERS,GRADES6-9,2010-11

data SoUrCE: YSS, 2010-11

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Quit attempts among youth aged 15-19Among current smokers aged 15-19, two-thirds (67.0%)hadevermadeaquitattempt.

Themajority(56.2%)ofcurrentsmokersandrecentquittersaged15-19hadmadeaquitattempt lasting at least 24 hours in the past 12 months: one-third had made one to three attemptsinthepast12months,while23%hadmade four or more attempts (Figure 11.4).

Between 2010 and 2011, there was no significant difference in the percentage of smokers aged 15-19whohadtriedtoquitsmokinginthepast12 months102. Since 1999, the percentage of smokersandrecentquitterswhohadattemptedtoquitinthepast12monthshasremainedapproximately stable, with some year-to-year fluctuation (Figure 11.5).

FigUrE 11.5: PERCENTAGEOFSMOKERSANDRECENTQUITTERS*WHOATTEMPTEDTOQUITIN THE PAST 12 MONTHS,AGED15-19,1999**-2011

*notE:IN1999-2002,THISQUESTIONWASASKEDOFCURRENTSMOKERS;2003(DATANOTSHOWN)INCLUDEDONLYSMOKERSWHOHADTRIEDTOQUITINTHEPAST2YEARS;2004-2011INCLUDEDCURRENTSMOKERSANDFORMERSMOKERSWHOHADQUITINTHEPAST12MONTHS** IN 1999, ONLY CYCLE 2 WAS ASKED THE RELEVANT SURVEY ITEMS. data SoUrCE: CTUMS, 1999-2011

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FigUrE 11.4: NUMBEROF24-HOURQUITATTEMPTSMADE IN THE PAST 12 MONTHS BY SMOKERS AND RECENTQUITTERS,AGED15-19,2011


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glossary


gloSSarY

CtUmSSmoking status has been defined to be consistent with the definitions used in other national Health Canada surveys that collect data on tobacco use.

Smoking prevalence: the estimated number of smokers in a specified group, divided by the total populationofthatgroup,expressedasapercentage;alsoreferredtoasthe“smokingrate”.

Cigarette consumption: the number of cigarettes reported smoked by either daily or occasional smokers. In this report, consumption is reported only for daily smokers.

Current smoker: includes daily and non-daily (occasional) smokers. Determined from the response tothequestion“Atthepresenttimedoyousmokecigaretteseveryday,occasionally,ornotatall?”

• Current daily smoker:referstothosewhorespond“everyday”tothequestion“Atthepresenttime doyousmokecigaretteseveryday,occasionallyornotatall?”

• Current non-daily smoker:oftenreferredtoas“occasional”smoker,referstothosewhorespond“Occasionally”tothequestion“Atthepresenttimedoyousmokecigaretteseveryday,occasionally ornotatall?”

Former smoker:wasnotsmokingatthetimeoftheinterview,however,answered“YES”tothequestion “Haveyousmokedatleast100cigarettesinyourlife?”

Ever-smokers: current and former smokers combined.

never-smoker:wasnotsmokingatthetimeoftheinterviewandanswered“NO”tothequestion “Haveyousmokedatleast100cigarettesinyourlife?”

non-smokers: former smokers and never-smokers combined.

Quitter percentage: the ratio of the number of former smokers in a specified group divided by the number of ever-smokers in that group.

YSSCurrent smoker: has smoked at least 100 cigarettes in his/her lifetime; includes daily and non-daily smokers.

• Current daily smoker: a current smoker who has smoked at least one cigarette per day for each of the 30 days preceding the survey.

• Current non-daily smoker: a current smoker who has smoked at least one cigarette during the past 30 days, but has not smoked every day.

Former smoker: smoked at least 100 cigarettes in his/her lifetime and has not smoked at all during the past 30 days.

Experimental smoker (beginner): has smoked at least one whole cigarette and has smoked in the last 30 days.

Former experimental smoker (past experimenter): has smoked at least one whole cigarette and has not smoked at all in the past 30 days.

Puffer:someonewhohasjusttriedafewpuffsofacigarette,buthasneversmokedawholecigarette.

Ever tried a cigarette: someone who has ever tried a cigarette, even a few puffs.

never tried a cigarette: someone who has never tried a cigarette, not even a few puffs.

Smoking prevalence: the estimated number of smokers in a specified group, divided by the total population of that group, expressed as a percentage.

Cigarette consumption: the average number of cigarettes smoked per day by daily smokers.

index oF sTaTisTiCal TesTs


indEx oF StatiStiCal tEStS WWald test used to compute the p-value (binary variables)FF test used to compute the p-value (continuous variables)RRegression of the log of the outcome variable on time

1Difference in overall smoking prevalence between 2010 and 2011: p=0.43W

2Difference in daily smoking prevalence between 2010 and 2011: p=0.32W

3Difference in non-daily smoking prevalence between 2010 and 2011: p=0.79W

4Overalleffectoftime(1999-2011)onsmokingprevalence:p<0.0001F5Overallannualrateofdeclineinprevalence,1999-2011=3.17%;relationshipoflogprevalenceandtime:p<0.0001R6Differenceinoverallsmokingprevalencebetweenmalesandfemalesin2011:p<0.0001W7Difference in daily smoking prevalence between males and females in 2011: p=0.001W 8Difference in non-daily smoking prevalence between males and females in 2010: p=0.01W

9Differenceincurrentsmokingprevalenceamongmalesbetween2010and2011:p=0.96W

10Difference in current smoking prevalence among females between 2010 and 2011: p=0.19W

11Differenceinsmokingprevalencebetweenagegroupsin2011:p<0.0001W12Differenceinsmokingprevalencebetweeneducationalgroupsin2011:p<0.0001W13Differenceindailysmokingprevalencebetweeneducationalgroupsin2011:p<0.0001W14Difference in non-daily smoking prevalence between educational groups in 2011: p=0.11W

15Difference in consumption between 2010 and 2011: p=0.11F

16Overalleffectoftime(1999-2011)onconsumption:p<0.0001F 17Overallannualrateofdeclineinconsumption,1999-2011=1.36%;relationshipoflogCPDandtime:p<0.0001R18Differenceinconsumptionbetweenmalesandfemalesin2011:p=0.006F

19Differenceinconsumptionbetweenagegroupsin2011:p<0.0001F20Difference in consumption between educational groups in 2010: p=0.007F

21Difference in smoking prevalence between provinces in 2011: p=0.04W

22Difference in consumption between provinces in 2011: p=0.09F

23Differenceincigarillousebetweenmalesandfemalesin2011:p<0.0001W24Differenceincigarusebetweenmalesandfemalesin2011:p<0.0001W25Differenceinpipeusebetweenmalesandfemalesin2011:p<0.0001W26Differenceinchewingtobacco/snuffusebetweenmalesandfemalesin2011:p<0.0001W27Differenceinwaterpipeusebetweenmalesandfemalesin2011:p<0.0001W28Differenceincigarillousebetweenagegroupsin2011:p<0.0001W29Differenceincigarusebetweenagegroupsin2011:p<0.0001W30Differenceinpipeusebetweenagegroupsin2011:p<0.0001W31Difference in chewing tobacco/snuff use between age groups in 2011: p=0.0002W

32Differenceinwaterpipeusebetweenagegroupsin2011:p<0.0001W33Difference in cigar/cigarillo use between provinces in 2011: p=0.02W

34Difference in use of roll-your-own (at least sometimes) between 2010 and 2011: p=0.13W

35Difference in use of roll-your-own (at least sometimes) between males and females in 2011: p=0.0008W

36Differencein‘allthetime’useofroll-your-ownbetweenmalesandfemalesin2011:p=0.25W

37Differencein‘mostofthetime’useofroll-your-ownbetweenmalesandfemalesin2011:p=0.03W

38Differencein‘sometimes’useofroll-your-ownbetweenmalesandfemalesin2011:p=0.003W

39Difference in use of roll-your-own (at least sometimes) between age groups in 2011: p=0.22W

40Differenceinuseofroll-your-own(atleastsometimes)betweenprovincesin2011:p<0.0001W41Differenceinquitterpercentagebetweenmalesandfemalesin2011:p=0.09W

42Differenceineversmokingbetweenmalesandfemalesin2011:p<0.0001W43Differenceincurrentsmokingbetweenmalesandfemalesin2011:p<0.0001W44Differenceinquitterpercentagebetweenagegroupsin2011:p<0.0001W45Differencein6-monthquitintentionsbetween2010and2011:p=0.01W46Differencein30-dayquitintentionsbetween2010and2011:p=0.11W47Differencein6-monthquitintentionsbetweenmalesandfemalesin2011:p=0.76W

48Differencein30-dayquitintentionsbetweenmalesandfemalesin2011:p=0.16W

49Differencein6-monthquitintentionsbetweenagegroupsin2011:p=0.005W

index oF sTaTisTiCal

TesTs


50Differencein30-dayquitintentionsbetweenagegroupsin2010:p=0.01W51Differenceinhavingmadeaquitattemptinthepastyearbetween2010and2011:p=0.59W

52Differenceinhavingmadeaquitattemptinthepastyearbetweenmalesandfemalesin2011:p=0.61W53Differenceinhavingmadeaquitattemptinthepastyearbetweenagegroupsin2011:p=0.001W54Differenceinquitsuccess(amongattemptersinthepastyear)between2010and2011:p=0.73W

55Differenceinquitsuccess(amongattemptersinthepastyear)betweenmalesandfemalesin2011:p=0.03W

56Differenceinquitsuccess(amongattemptersinthepastyear)betweenagegroupsin2011:p=0.79W

57Differenceinevertryingacigarettebetweenmalesandfemalesin2010-11,grades6-9:p=0.01W58Differenceinevertryingacigarettebetween2008-09and2010-11,grades6-9:p<0.0001W59Differenceinevertryingacigarettebetweenprovincesin2010-11,grades6-9:p<0.0001W60Difference in ever smoking a whole cigarette between 2010 and 2011, age 15-19: p=0.37W

61Difference in ever smoking a whole cigarette between males and females in 2010, age 15-19: p=0.0001W

62Differenceinsusceptibilitybetween2008-09and2010-11,grades6-9:p=0.72W

63Differenceinsusceptibilitybetweenmalesandfemalesin2010-11,grades6-9:p=0.02W

64Differenceinsusceptibilitybetweenprovincesin2010-11,grades6-9:p<0.0001W65Differenceinsmokingprevalencebetween2008-09and2010-11,grades6-9:p=0.001W66ifferenceindailysmokingprevalencebetween2008-09and2010-11,grades6-9:p=0.01W67Differenceinnon-dailysmokingprevalencebetween2008-09and2010-11,grades6-9:p=0.01W68Difference in smoking prevalence between 2010 and 2011, age 15-19: p=0.68W

69Difference in daily smoking prevalence between 2010 and 2011, age 15-19: p=0.06W

70Difference in non-daily smoking prevalence between 2010 and 2011, age 15-19: p=0.21W

71Differenceinsmokingprevalencebetweenmalesandfemalesin2010-11,grades6-9:p=0.67W

72Difference in smoking prevalence between males and females in 2011, age 15-19: p=0.13W

73Differenceinsmokingprevalencebetweenprovincesin2010-11,grades6-9:p<0.0001W74Differenceinsmokingprevalencebetweenprovincesin2011,age15-19:p<0.0001W75Differenceinconsumptionbetween2008-09and2010-11,grades7-9:p=0.16F

76Difference in consumption between 2010 and 2011, age 15-19: p=0.89F

77Difference in consumption between males and females in 2010-11, grades 7-9: p=0.73F

78Differenceinconsumptionbetweenmalesandfemalesin2011,age15-19:p=0.69F

79Difference in cigar/cigarillo use between 2010 and 2011, age 15-19: p=0.28W

80Difference in pipe use between 2010 and 2011, age 15-19: p=0.38W

81Difference in chewing tobacco/snuff use between 2010 and 2011, age 15-19: p=0.72W

82Differenceincigar/cigarillousebetween2008-09and2010-11,grades6-9:p<0.0001W83Differenceinpipeusebetween2008-09and2010-11,grades6-9:p=0.02W

84Differenceinsmokelesstobaccousebetween2008-09and2010-11,grades6-9:p=0.08W 85Differenceincigar/cigarillousebetweenmalesandfemalesin2011,age15-19:p<0.0001W86Differenceinpipeusebetweenmalesandfemalesin2011,age15-19:p<0.0001W87Differenceinchewingtobacco/snuffusebetweenmalesandfemalesin2011,age15-19:p<0.0001W88Difference in waterpipe use between males and females in 2011, age 15-19: p=0.002W

89Differenceincigar/cigarillousebetweenmalesandfemalesin2010-11,grades6-9:p=0.002W

90Differenceinpipeusebetweenmalesandfemalesin2010-11,grades6-9:p<0.0001W91Differenceinsmokelesstobaccousebetweenmalesandfemalesin2010-11,grades6-9:p=0.006W

92Differenceinwaterpipeusebetweenmalesandfemalesin2010-11,grades6-9:p=0.12W

93Differenceincigar/cigarillousebetweenprovincesin2010-11,grades6-9:p<0.0001W94Differenceinpipeusebetweenprovincesin2010-11,grades6-9:p<0.0001W95Differenceinsmokelesstobaccousebetweenprovincesin2010-11,grades6-9:p=002W

96Differenceinwaterpipeusebetweenprovincesin2010-11,grades6-9:p<0.0001W97Differenceincigar/cigarillousebetweenprovincesin2011,age15-19:p<0.0001W98Difference in pipe use between provinces in 2011, age 15-19: p=0.11W

99Differenceinchewingtobacco/snuffusebetweenprovincesin2011,age15-19:p<0.0001W100Differenceinwaterpipeusebetweenprovincesin2011,age15-19:p<0.0001W101Differenceineverhavingmadeaquitattemptbetween2008-09and2010-11,smokersingrade6-9:p=0.31W102Differenceinhavingmadeaquitattemptinthepast12monthsbetween2010and2011,smokersage15-19:p=0.12W

rEFErEnCES

i World Health Organization. (2004). global Burden of Disease 2004 - Americas. Available online: http://www.who.int/healthinfo/global_burden_disease/risk_factors/en/index.html

ii Baliunas, D., Patra, J., Rehm, J., Popova, S., Kaiserman, M., & Taylor, B. (2007). Smoking-attributable mortality and expected years of life lost in Canada 2002: Conclusions for prevention and policy. Chronic Diseases in Canada,27(4),154-162.

iii Rehm,J.,Baliunas,D.,Brochu,S.,Fischer,B.,Gnam,W.,Patra,J.,etal.(2006).The Costs of Substance Abuse in Canada, 2002. Ottawa: Canadian Centre on Substance Abuse.

iv Physicians for a Smoke-free Canada. (2008, August). Smoking in Canada: Percentage of Canadians whosmoke(oneitheradailyoroccasionalbasis),federalsurveys,1965-2007.Ottawa:Physiciansfora Smoke-free Canada. Available online: http://www.smoke-free.ca/factsheets/pdf/prevalence.pdf

v Smoking and Health Action Foundation. (2011). Cigarette prices in Canada: A map comparing the price of a carton of 200 cigarettes in Canada’s provinces and territories, as of April 13, 2011. Available online: http://www.nsra-adnf.ca/cms/file/files/pdf/cigarette_prices_Canada_13_April_2011_map_and_table.pdf

vi Royal Canadian Mounted Police. (2008). 2008 Contraband Tobacco Enforcement Strategy. Ottawa: RCMP. Available online: http://www.rcmp-grc.gc.ca/ce-da/tobacco-tabac-strat-2008-eng.htm.

vii Task Force on Illicit Tobacco Products. (2010, July). Report on the status of the contraband tobacco situation in Canada. Ottawa: Presented to the Minister Of Public Safety. Available online: http://www.publicsafety.gc.ca/prg/le/_fl/ct-rpt-eng.pdf (accessed December 14, 2010).

viii Health Canada. (2010, July 5). government of Canada Ban on Flavoured Tobacco Products now in Full Force [NewsRelease2010-112].Availableonline:http://www.hc-sc.gc.ca/ahc-asc/media/ nr-cp/_2010/2010_112-eng.php

ix Ontario Tobacco Research Unit. (2011). Tobacco Taxes: monitoring Update. Toronto: Ontario Tobacco Research Unit. Available online: http://otru.org/wp-content/uploads/2012/06/taxes2011.pdf

x Health Canada. (2002). 2000-2002 Report on Tobacco Control - An Update. Available online: http://www.hcsc.gc.ca/hl-vs/pubs/tobac-tabac/report-rapport/index_e.html

xi Pierce,J.P., Choi,W.S., Gilpin,E.A., Farkas,A.J.,&Merritt,R.K.(1996).validationofsusceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychology 15, 355-361.

xii Klein,S.M.,Giovino,G.A.,Barker,D.C.,Tworek,C.,Cummings,K.M.,&O’Connor,R.J.(2008). Use of flavored cigarettes among older adolescent and adult smokers: United States, 2004--2005. nicotine & Tobacco Research 10, 1209-14.

reFerenCes


aPPendiCes


aPPEndix a: Canadian tobacco Use monitoring SurveyThe Canadian Tobacco Use Monitoring Survey (CTUMS) is conducted by Statistics Canada with the cooperation and support of Health Canada. CTUMS was developed to provide Health Canada and its partners with timely, reliable, and continual data on tobacco use and related issues. CTUMS uses a repeated cross-sectional survey design. Starting in 1999, data has been collected from February to December of each year, using computer-assisted random-digit-dialed telephone interviews.

The samples for CTUMS are selected using a two-phase stratified random sampling procedure. The two-phase design is used in order to increase the representation in the sample of respondents belonging to the 15 to 19 and 20 to 24 age groups, which are populations that are most at risk of becoming smokers. In the first phase, households are selected using random-digit-dialing. In the second phase, one or two individuals (or none) are selected based upon household composition. This ensures the representation of individuals in the younger age groups because the random selection was implemented such that at least one person in the 15 to 19 or 20 to 24 age groups would be selected within a household, if they existed. The samples include the population of Canada aged 15 years and over, excluding residents of Yukon, Northwest Territories and Nunavut, as well as full-time residents of institutions and individuals without telephones or with cell phones only. Every year from 1999-2010, CTUMS released two semi-annual files and a yearly summary; this report uses the yearly summary data sets, except where noted. Starting in 2011, only an annual file is released each year.

CtUmS datasets and documentation are available at: http://www.statcan.gc.ca/dli-ild/data-donnees/ftp/ctums-esutc/2011survey-tobacco-enquete-tabac-eng.htm

aPPEndix b: Youth Smoking SurveyTheYouthSmokingSurvey(YSS)monitorstobaccouseinschoolagedchildren(grades6-9/10-12).TheYSScollects data on the smoking behaviour of students, social and demographic factors, attitudes and beliefs about smoking, cigarette purchasing and other policy-relevant items, as well as experience with alcohol and drugs. The YSS uses a repeated cross-sectional survey design. To date, six waves of the YSS have been conducted:1994,2002,2004-05,2006-07,2008-09,and2010-11.

YSSdataiscollectedthroughclassroom-basedsurveysofstudentsingrades6to9(andgrades10-12in 2006-07,2008-09,and2010-11;grade5wasalsoincludedinwavespriortoandincluding2006-07)attending a representative sample of private, public, and Catholic schools. Sampling procedures varied by survey wave.

• In2010-11,schoolswererandomlysampledwithineachof9provinces,usingastratifiedsinglestagedesign. Participation in the 2010-11 YSS was declined by the province of New Brunswick. Based on comparative analysis conducted using 2008-09 survey data, there were no statistically significant differencesinnationalestimatesforcurrent(p=0.66)oreversmoking(p=0.68)withandwithout New Brunswick.

• In2008-09,schoolswererandomlysampledwithineachofthe10provinces,usingastratifiedsinglestage sampling design. Using this sampling design, within each province except Ontario, stratification was based on two classifications: 1) health region smoking rate (above or below median); and 2) type of school(elementaryorsecondary).ForOntario,thedesignincludedathirdstratum,theGreaterTorontoArea(GTA).TheGTAstratumconsistedofallschoolsintheGTA,definedascomprisingfivehealthunitregions:Toronto,York,Peel,HaltonandDurham.OutsidetheGTA,thepopulationofOntarioschoolswasdivided in two health region strata, similar to the other provinces.

• In2006-07,schoolswererandomlysampledwithineachofthe10provinces,usingastratifiedclusteredsampling design. Using this sampling design, within each province, stratification was based on two classifications: 1) health region smoking rate (above or below median); and 2) type of school (elementary or secondary).

• In2004-05,thesamplingofschoolswasconductedintwostages.Atstage1,schoolboardsweresampled within each province using a stratified sampling design. The school boards were rank ordered based on their adult smoking rates and each board was assigned to one of the two strata (low vs. high smoking rate) so that approximately half the total student enrolment in any province was assigned to each stratum.

aPPendiCes


From the selected school boards, schools were then sampled. Schools were stratified into two strata, theseniorstratum(seniorelementaryorhighschoolgrades)andthejuniorstratum(juniorelementarygrades).

• In2002,gradeswithinschoolsweresampled.Thesampledesignfeaturedthreelevelsofstratification,byprovince, by grade and the schools were stratified by census metropolitan area (CMA) versus non-CMA. A school may be selected more than once, for different grades.

• The1994YSShadasamplingdesignsimilarto2002,withtheexceptionthatthereweretwolevelsofstratification: province and grade. In all years, the sample excludes residents of the Yukon, Nunavut and Northwest Territories, residents of institutions, residents of First Nations reserves, and those attending special schools (e.g., schools for visually-/hearing-impaired individuals) or schools located on military bases.

• In2004-05through2010-11,allstudentswithinparticipatingschools/classroomswereinvitedtoparticipate in the survey. In 1994 and 2002, one class was randomly selected in the desired grade in the selected schools and all students within each selected class were invited to participate in the survey.

Participating students completed a 30-40 minute written survey within their classroom; these surveys werescanned(in2004-05,2006-07,2008-09and2010-11)ordatacaptured(in1994and2002)and cleanedtocreatethefinaldatasets.In1994,allgrades5to9studentsrespondedtothesamequestionnaire. In2002and2004-05,grade5and6studentsrespondedtoaversionofthequestionnairethathadthe samequestionsansweredbygrade7to9studentswiththeexceptionthatitdidnotincludethealcohol anddrugquestions.

In2006-07,grade5and6studentsrespondedtoaquestionnairethatdidnotincludealcoholanddrugquestions,andineachclassofgrade7to9students(andgrade10to12students),studentswererandomlyselectedtoreceiveoneoftwoversionsofthequestionnairewithalcoholanddrugquestions.Forthisreason,theYSS2006-07datahastwosurveyweights(ratherthanone,asinotheryears),theuseofwhichdepends on which module(s) included the variables being analysed (this information can be found in the supplementaryuserguideforYSS2006-07).In2008-09and2010-11,grade6studentsrespondedtoaversionofthequestionnairethathadthesamequestionsansweredbygrade7to9students(andgrade10 to12students)withtheexceptionthatitdidnotincludethealcoholanddrugquestions.

additional information on the YSS is available at: http://www.yss.uwaterloo.ca/

YSS datasets are available from the Propel Population health data repository (Phdr) at: http://www.propel.uwaterloo.ca/index.cfm?section=28&page=424

aPPEndix C: data analysisData analysis was completed by Robin Burkhalter, MMath, Vicki Rynard, MSc, and Rashid Ahmed, PhD, of the Propel Centre for Population Health Impact, using datasets made available by Statistics Canada and Health Canada. Statistical review was provided by K. Stephen Brown, PhD, of the Propel Centre for Population Health Impact and the Department of Statistics & Actuarial Science, University of Waterloo.

This report does not necessarily reflect the views or opinions of Statistics Canada or Health Canada.

EstimatesThe data presented in this report are weighted estimates, unless otherwise noted. The CTUMS survey weights assigned by Statistics Canada in the annual datasets were used for CTUMS analyses, and YSS survey weights were used for YSS analyses; CTUMS and YSS were not analysed together and there was no overlap of the surveyweightsbetweenthetwosurveys.EstimatesforcategoricalmeasuresweregeneratedusingtheFREQprocedure in SAS statistical software (Version 9.2), while estimates for continuous variables (e.g. cigarettes per day) were generated using the MEANS procedure in SAS. Estimates and confidence intervals were generated using the statistical software STATA 10.1 using the bootstrap weights where they were available (CTUMS 2001 to 2011 and YSS 2004-05 to 2010-11).

aPPendiCes


ReportingConfidence intervals are available as supplementary material on the website, but are not included in this report; caution should be used when making comparisons without first checking the confidence intervals. Estimates are not reported where specific categories included less than 30 individuals (unweighted). In addition to this rule, Health Canada also recommends calculating the coefficient of variation to determine thequalityleveloftheestimate(forfurtherinformation,pleaserefertothedocumentationforspecificsurveysandwaves/years).Asaresult,someestimatesincludedinthisreportmaybereported“withcaution”or not reported by Health Canada in their releases.

RoundingEstimates in figures and the associated data tables have been rounded to one decimal place. Provincial estimates for numbers of smokers reported in sections 2.1-2.10 have been rounded to the nearest thousand.

Significance testingStatisticalcomparisonsbetweengroups/yearsweretestedusingregressionanalysis,withp<0.05asthecut-off for significance. Bootstrap weights were used to perform significance testing between groups or between the latest two years, where they were available (CTUMS 2001 to 2011 and YSS 2004-05 to 2010-11). The statistical comparisons were performed using the SURvEYlOgISTIC procedure in SAS statistical software (Version 9.2) for all binary response variables. For the continuous variable of cigarettes per day, comparisons were performed using the SURvEYREg procedure in SAS. Comparisons of prevalence rate and cigarettes per day(CPD)overthetimeperiod1999-2011(#4,#5,#16and#17)weretestedusingadatasetoftheprevalencerates and CPD by year. The glm procedure in SAS was used with the yearly prevalence rate regressed on year for#4,thelogofyearlyprevalencerateregressedonyearfor#5,yearlyCPDregressedonyearfor#16andlog of yearly CPD regressed on year for #17.

Where statistical testing has been performed, comparisons are marked with a superscript number, which refers to a p-value that can be found in the Index of Statistical Tests (page 91). Throughout the report, the term“significant”hasbeenreservedforinstanceswherestatisticaltestinghasbeenperformedatthe5%oflevelofsignificance(i.e.,p<0.05).

data for Section iii (Youth)BothYSSandCTUMSdatawereusedfortheyouthanalysis:YSSdatawereusedforyouthingrades6-9,whowere approximately aged 10-14, and CTUMS was used for youth aged 15-19. Earlier waves of the YSS included students in grade 5, who are not included in this report for purposes of comparability between survey waves. The two most recent waves of the YSS (2008-09 and 2010-11) also included students in grades 10-12, but these students were not included in the analysis due to their overlap in age with the CTUMS sample; CTUMS was selected as the data source for older youth since the sampling frame includes youth both in and out of school, whereas the YSS only samples youth who are attending school.

YSSandCTUMSdatahavebeenintegratedwherepossible.However,differencesinthequestionsaskedoneach survey and the timing of the surveys does not allow for parallel reporting of all measures. The most recent wave was 2011 for CTUMS, and 2010-11 for the YSS. The YSS runs on school years (data collection between September and June), while CTUMS runs on calendar years (data collection from February to December).DatacollectedviatheYSS(grades6-9)arepresentedbygraderatherthanage,asthesurveywas school-based and sampling was done by grade. CTUMS is not school-based, so data are presented by age.

The YSS and CTUMS base their definition of a current smoker on different items: the YSS defines a current smoker as having smoked at least 100 cigarettes in his/her lifetime and smoked in the 30 days preceding the survey; CTUMS define a current smoker using theirresponsetothequestion“Atthepresenttimedoyousmokecigaretteseveryday,occasionally,ornotatall?”.

Founded by the Canadian Cancer Society and University of Waterloo, the Propel Centre for Population Health Impact is a pan-Canadian collaborative enterprise that conducts research, evaluation and

knowledge exchange to accelerate improvements in the health of populations. Propel’s niche is relevant and rigorous science that informs policies and practice to prevent cancer and chronic disease.

Propel Centre for Population health impactLyle S. Hallman Institute, University of Waterloo

200 University Avenue WestWaterloo,Ontario,CanadaN2L3G1

Telephone:519-888-4520•Fax:519-746-8171E-mail:[email protected]•www.propel.uwaterloo.ca

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